# RICHARDSON ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760497291
- **Authorized official:** MIRO A. PAVELKA JR. D.D.S. (OWNER/PRESIDENT)
- **Authorized official phone:** (972) 231-6661

## Contact information

- **Practice address:** 400 S COTTONWOOD DR, SUITE B, RICHARDSON, TX 75080-5708
- **Practice address phone:** (972) 231-6661
- **Practice address fax:** (972) 231-3161
- **Mailing address:** 400 S COTTONWOOD DR, SUITE B, RICHARDSON, TX 75080-5708
- **Mailing address phone:** (972) 231-6661
- **Mailing address fax:** (972) 231-3161

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 11521 | TX | Yes |

## Other

- **Enumeration date:** 07/31/2006
- **Last updated:** 09/15/2008