Healthcare Provider Details

I. General information

NPI: 1073868709
Provider Name (Legal Business Name): SA ORAL SURGEONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8611 HILLCREST AVE STE. 235
DALLAS TX
75225-4207
US

IV. Provider business mailing address

8611 HILLCREST AVE STE. 235
DALLAS TX
75225-4207
US

V. Phone/Fax

Practice location:
  • Phone: 214-269-1244
  • Fax: 214-269-1245
Mailing address:
  • Phone: 214-269-1244
  • Fax: 214-269-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number19330
License Number StateTX

VIII. Authorized Official

Name: MR. EMILIO G CRUZ
Title or Position: MANAGER
Credential:
Phone: 214-543-1453