| NPI | 1255710752 |
|---|---|
| Doing Business As | TEXOMA FACIAL AND ORAL SURGERY |
| Entity Type | Organization |
| Authorized Contact | CLARK ALLEN PETERSEN Operations Director 618-402-6622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 24871) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2015-05-29 |