Organization
CENTRAL TEXAS ORAL SURGERY ASSC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANKLIN SAMUEL BONASSO DDS (ORAL SURGEON)
(512) 320-1640
Entity
Organization
Contact information
Practice address
3200 RED RIVER, #400, AUSTIN, TX 78705
(512) 320-1640
(512) 320-1643
Mailing address
3200 RED RIVER, #400, AUSTIN, TX 78705
(512) 320-1640
(512) 320-1643
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
18515
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015705
ASSURANT
TX
01
—
D18515
BLUE CROSS BLUE SHIELD
TX
Enumeration date
09/27/2006
Last updated
08/22/2020
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