Organization
COLLEGE STATION ORAL SURGERY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE CARRANZA (GENERAL MANAGER)
(979) 316-5000
Entity
Organization
Contact information
Practice address
1645 GREENS PRAIRIE RD W STE 202, COLLEGE STATION, TX 77845-8414
(979) 316-5000
Mailing address
24437 KATY FWY STE 500, KATY, TX 77494-1469
(281) 394-9340
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
08/28/2019
Last updated
08/28/2019
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