Healthcare Provider Details

I. General information

NPI: 1932521994
Provider Name (Legal Business Name): TOEPPERRICAN OROFACIAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11515 TOEPPERWEIN RD SUITE 100
LIVE OAK TX
78233-3151
US

IV. Provider business mailing address

11515 TOEPPERWEIN RD SUITE 100
LIVE OAK TX
78233-3151
US

V. Phone/Fax

Practice location:
  • Phone: 210-202-0406
  • Fax: 210-978-5505
Mailing address:
  • Phone: 210-202-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DAVID V MALAVE
Title or Position: MEMBER CO-PRINCIPAL
Credential: D.M.D.
Phone: 210-202-0406