Healthcare Provider Details

I. General information

NPI: 1073732277
Provider Name (Legal Business Name): HOUSTON ORAL SURGERY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 SAN FELIPE ST SUITE 300
HOUSTON TX
77063-1707
US

IV. Provider business mailing address

7500 SAN FELIPE ST SUITE 300
HOUSTON TX
77063-1707
US

V. Phone/Fax

Practice location:
  • Phone: 713-457-6337
  • Fax: 713-457-6341
Mailing address:
  • Phone: 713-457-6337
  • Fax: 713-457-6341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number19580
License Number StateTX

VIII. Authorized Official

Name: DR. DIETER J. MOYA
Title or Position: DOCTOR, OWNER
Credential: D.D.S.
Phone: 713-457-6337