Organization
WICHITA FALLS ORAL AND FACIAL SURGERY, PLLC
Active
Other names
Texoma Facial and Oral Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLARK ALLEN PETERSEN JR. (OPERATIONS DIRECTOR)
(618) 402-6622
Entity
Organization
Contact information
Practice address
2304 MIDWESTERN PKWY, SUITE 102, WICHITA FALLS, TX 76308-2342
(940) 696-1544
Mailing address
4447 N CENTRAL EXPY, SUITE 110, PMB 434, DALLAS, TX 75205-4245
(800) 215-6530
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
24871
TX
Other
Enumeration date
05/29/2015
Last updated
05/29/2015
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