# LAKE JACKSON ORAL AND MAXILLOFACIAL SURGERY, PLLC

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

## Provider details

- **NPI number:** 1831557370
- **Authorized official:** NATHAN PHILLIPS DDS (PROVIDER)
- **Authorized official phone:** (979) 299-6878

## Contact information

- **Practice address:** 103 ABNER JACKSON PKWY, LAKE JACKSON, TX 77566-5163
- **Practice address phone:** (979) 299-6878
- **Practice address fax:** (979) 299-6166
- **Mailing address:** 103 ABNER JACKSON PKWY, LAKE JACKSON, TX 77566-5163
- **Mailing address phone:** (979) 299-6878
- **Mailing address fax:** (979) 299-6166

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 16829 | TX | Yes |

## Other

- **Enumeration date:** 01/28/2016
- **Last updated:** 01/28/2016