Organization
CENTRAL TX ORAL & MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAVELLE FORD D.D.S (PRESIDENT/OWNER)
(254) 699-9500
Entity
Organization
Contact information
Practice address
2030 HEIGHTS DR STE 3, HARKER HEIGHTS, TX 76548-2185
(254) 699-9500
(254) 699-2796
Mailing address
2030 HEIGHTS DR STE 3, HARKER HEIGHTS, TX 76548-2185
(254) 699-9500
(254) 699-2796
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
17564
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110929001
—
TX
05
—
110929003
—
TX
Enumeration date
11/13/2007
Last updated
06/22/2012
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