Organization
CORPUS CHRISTI ORAL AND MAXILLOFACIAL SURGEONS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA HENDRICKS (INSURANCE CLERK)
(361) 993-2290
Entity
Organization
Contact information
Practice address
5756 S STAPLES ST F, CORPUS CHRISTI, TX 78413-3796
(361) 993-2290
(361) 992-4961
Mailing address
5756 S STAPLES ST, CORPUS CHRISTI, TX 78413-3796
(361) 993-2290
(361) 992-4961
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0098105-01
—
TX
05
—
0811788-01
—
TX
01
—
G60013-1
DELTA TX CHIPS
TX
Enumeration date
06/15/2006
Last updated
01/10/2013
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