Healthcare Provider Details

I. General information

NPI: 1629067657
Provider Name (Legal Business Name): RECONSTRUCTIVE ORAL AND MAXILLOFACIAL SURGERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 W TRENTON RD
EDINBURG TX
78539-3432
US

IV. Provider business mailing address

2601 W TRENTON RD
EDINBURG TX
78539-3432
US

V. Phone/Fax

Practice location:
  • Phone: 956-664-1695
  • Fax: 956-664-1798
Mailing address:
  • Phone: 956-664-1695
  • Fax: 956-664-1798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. FRANCISCO M PEREZ
Title or Position: DOCTOR CO OWNER
Credential: DMD MSD
Phone: 956-664-1695