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Organization
EAST TEXAS ORAL & MAXILLOFACIAL SURGERY ASSOCIATES INC.
Active
Organization
EAST TEXAS ORAL & MAXILLOFACIAL SURGERY ASSOCIATES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE MARIE WILKS (OFFICE MANAGER)
(903) 758-3444
Entity
Organization
Contact information
Practice address
3004 H G MOSELEY PKWY, LONGVIEW, TX 75605-2948
(903) 758-3444
(903) 758-1967
Mailing address
3004 H G MOSELEY PKWY, LONGVIEW, TX 75605-2948
(903) 758-3444
(903) 758-1967
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
10700
TX
Other
Enumeration date
01/08/2007
Last updated
03/20/2012
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