NPI | 1831324052 |
---|---|
Former Legal Business Name | CAPROCK ORAL & MAXILLOFACIAL SURGERY, P.A. |
Entity Type | Organization |
Authorized Contact | GLADYS JOHNSON WHITTEN Oral & Maxillofacial Surgeon/ Pres. 806-535-0238 |
Organization Subpart ? | No |
Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 11953) |
Enumeration Date | 2009-05-18 |
Last Update Date | 2014-10-01 |