Healthcare Provider Details

I. General information

NPI: 1225398456
Provider Name (Legal Business Name): ASSOCIATES IN ORAL & IMPLANT SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 NORTH MESA SUITE 1 SOUTH
EL PASO TX
79912
US

IV. Provider business mailing address

7211 NORTH MESA SUITE 1 SOUTH
EL PASO TX
79912
US

V. Phone/Fax

Practice location:
  • Phone: 915-581-7800
  • Fax: 915-587-8995
Mailing address:
  • Phone: 915-581-7800
  • Fax: 915-587-8995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number12943
License Number StateTX

VIII. Authorized Official

Name: DR. RONALD C.D. BUTLER
Title or Position: ORAL SURGEON/PRESIDENT
Credential: DDS
Phone: 915-581-7800