1003014416 NPI number — SOUTHWEST CENTER FOR ORAL AND MAXILLOFACIAL SURGERY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003014416 NPI number — SOUTHWEST CENTER FOR ORAL AND MAXILLOFACIAL SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST CENTER FOR ORAL AND MAXILLOFACIAL SURGERY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003014416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5819 HIGHWAY 6
Provider Second Line Business Mailing Address:
SUITE #350
Provider Business Mailing Address City Name:
MISSOURI CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77459-4052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-933-9950
Provider Business Mailing Address Fax Number:
281-933-9953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5819 HIGHWAY 6
Provider Second Line Business Practice Location Address:
SUITE #350
Provider Business Practice Location Address City Name:
MISSOURI CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77459-4052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-933-9950
Provider Business Practice Location Address Fax Number:
281-933-9953
Provider Enumeration Date:
07/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LITZMAN
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
INSURANCE
Authorized Official Telephone Number:
281-933-9950

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com