Organization
LAKE JACKSON ORAL AND MAXILLOFACIAL SURGERY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN PHILLIPS DDS (PROVIDER)
(979) 299-6878
Entity
Organization
Contact information
Practice address
103 ABNER JACKSON PKWY, LAKE JACKSON, TX 77566-5163
(979) 299-6878
(979) 299-6166
Mailing address
103 ABNER JACKSON PKWY, LAKE JACKSON, TX 77566-5163
(979) 299-6878
(979) 299-6166
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
16829
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3377855
—
TX
Enumeration date
01/28/2016
Last updated
01/28/2016
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