Organization
TEXAS ORAL AND FACIAL SURGERY
Active
Organization
TEXAS ORAL AND FACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND L WIGGINS D.D.S., M.D. (DR)
(281) 395-1200
Entity
Organization
Contact information
Practice address
810 S MASON RD, SUITE 301, KATY, TX 77450-3895
(281) 395-1200
(281) 395-1201
Mailing address
810 S MASON RD, SUITE 301, KATY, TX 77450-3895
(281) 395-1200
(281) 395-1201
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
18986
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164989
DBP
TX
01
—
509663782
UCCI
TX
01
—
51107
ASSURANCE
TX
01
—
88D134
BC/BS PROVIDER
TX
Enumeration date
09/29/2005
Last updated
03/05/2013
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