Organization
ORAL AND FACIAL SURGERY INSTITUTE PA
Active
Other names
Oral and Facial Surgery Institute of Houston
Organization subpart
No
Provider details
NPI number
Authorized official
GINA CASU (CREDENTIALING MANAGER)
(713) 790-6477
Entity
Organization
Contact information
Practice address
6560 FANNIN ST STE 1522, HOUSTON, TX 77030
(713) 790-6477
(713) 790-6416
Mailing address
6560 FANNIN ST STE 1522, HOUSTON, TX 77030-2705
(713) 790-6477
(713) 790-6416
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
30279
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3376857
—
TX
Enumeration date
08/07/2018
Last updated
08/08/2018
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