| NPI | 1508146630 |
|---|---|
| Doing Business As | CASTLE ROCK ORAL AND FACIAL SURGERY |
| Entity Type | Organization |
| Authorized Contact | KRISTOPHER LARKIN HART President 254-449-6581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CO 10214) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 10214) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 21512) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX 21512) | |
| Enumeration Date | 2011-08-20 |
| Last Update Date | 2024-04-08 |