MEDICARE: BRAZOS ORAL & FACIAL SURGERY, PA

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
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1871316968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAZOS ORAL & FACIAL SURGERY, PA

Provider Business Mailing Address
First Line	:	103 BURNETT CT
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-3100
Country	:	US
Telephone Number	:	254-399-9925
Fax Number	:	254-399-9930

Provider Business Practice Location Address
First Line	:	103 BURNETT CT
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-3100
Country	:	US
Telephone Number	:	254-399-9925
Fax Number	:	254-399-9930

Authorized Official
Title or Position	:	PRACTICE LEADER
Name	:	WALTER PATRICK ARMSTRONG JR.
Credential	:
Telephone Number	:	254-399-9925

Provider Enumeration Date	:	11/06/2024
Last Update Date	:	11/06/2024

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