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NPI Code Detail

MEDICARE: TMHPO ORAL & MAXILLOFACIAL SURGERY

MEDICARE: TMHPO ORAL & MAXILLOFACIAL SURGERY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1204E00000XOral & Maxillofacial Surgery (D.M.D.)

General Provider Information

NPI Number : 1174544738
Entity Type Code : Organization
Provider Name (Legal Business Name) : TMHPO ORAL & MAXILLOFACIAL SURGERY
Provider Business Mailing Address
First Line : 6565 FANNIN ST
Second Line : D200
City : HOUSTON
State : TX
Zip : 77030-2703
Country : US
Telephone Number : 713-790-2221
Fax Number : 713-793-7092
Provider Business Practice Location Address
First Line : 6560 FANNIN ST
Second Line : SUITE 1228
City : HOUSTON
State : TX
Zip : 77030-2761
Country : US
Telephone Number : 713-441-5577
Fax Number : 713-793-7092
Authorized Official
Title or Position : PRESIDENT & CEO
Name : DR. HENRY DIRK SOSTMAN
Credential : MD
Telephone Number : 713-790-2221
Provider Enumeration Date : 07/21/2006
Last Update Date : 10/02/2009

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Directions to “TMHPO ORAL & MAXILLOFACIAL SURGERY ” Practice Location

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