# CENTER FOR ORAL & RECONSTRUCTIVE SURGERY P A

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

## Provider details

- **NPI number:** 1902112519
- **Authorized official:** DR. RAMSEY MATTHEW FANOUS D.D.S (DOCTOR/OWNER)
- **Authorized official phone:** (972) 359-8100

## Contact information

- **Practice address:** 400 N ALLEN DR, 207, ALLEN, TX 75013-2555
- **Practice address phone:** (972) 359-8100
- **Practice address fax:** (971) 359-8107
- **Mailing address:** 400 N ALLEN DR, 207, ALLEN, TX 75013-2555
- **Mailing address phone:** (972) 359-8100
- **Mailing address fax:** (971) 359-8107

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 16343 | TX | Yes |

## Other

- **Enumeration date:** 08/20/2010
- **Last updated:** 04/09/2015