Organization
SOUTHWEST ORAL & MAXILLOFACIAL SURGERY, P.A.
Active
Organization
SOUTHWEST ORAL & MAXILLOFACIAL SURGERY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLE RAE HILL (BUSINESS MANAGER)
(972) 644-8500
Entity
Organization
Contact information
Practice address
1001 BUCKINGHAM RD, SUITE 106, RICHARDSON, TX 75081-5850
(972) 644-8500
(972) 644-0104
Mailing address
1001 BUCKINGHAM RD, SUITE 106, RICHARDSON, TX 75081-5850
(972) 644-8500
(972) 644-0104
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
10599
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10599
TEXAS LICENSE NUMBER
TX
Enumeration date
11/04/2008
Last updated
11/04/2008
Update your record
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