Organization
FACIAL AND ORAL SURGERY ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN P. STELLA DDS (PRESIDENT)
(817) 927-1325
Entity
Organization
Contact information
Practice address
1625 SAINT LOUIS AVE, FORT WORTH, TX 76104-7635
(817) 927-1325
(817) 927-1497
Mailing address
1625 SAINT LOUIS AVE, FORT WORTH, TX 76104-7635
(817) 927-1325
(817) 927-1497
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009690101
—
TX
01
—
8116093
BCBS-BLUE LINK
TX
Enumeration date
04/10/2007
Last updated
01/15/2014
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