| NPI | 1154493922 |
|---|---|
| Former Legal Business Name | OLYMPIC PLAZA ORAL & MAXILLOFACIAL SURGERY ASSOC. |
| Entity Type | Organization |
| Authorized Contact | JERRI G. GRACE Office Manager 903-595-5186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 10456 & 17107) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2008-07-16 |