Healthcare Provider Details

I. General information

NPI: 1578674446
Provider Name (Legal Business Name): ORAL SURGERY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEDICAL PKWY SUITE 101
DALLAS TX
75234
US

IV. Provider business mailing address

10 MEDICAL PKWY SUITE 101
DALLAS TX
75234
US

V. Phone/Fax

Practice location:
  • Phone: 972-243-5035
  • Fax: 972-243-8574
Mailing address:
  • Phone: 972-243-5035
  • Fax: 972-243-8574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number190
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number08875
License Number StateTX

VIII. Authorized Official

Name: DR. ROBERT REX EATMON
Title or Position: PRESIDENT
Credential: DDS
Phone: 972-243-5035