Healthcare Provider Details

I. General information

NPI: 1275251118
Provider Name (Legal Business Name): RGV ORAL & MAXILLOFACIAL SURGICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4236 N MCCOLL RD STE C
MCALLEN TX
78504-2686
US

IV. Provider business mailing address

4236 N MCCOLL RD STE C
MCALLEN TX
78504-2686
US

V. Phone/Fax

Practice location:
  • Phone: 877-667-7669
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARYN SHERFIELD
Title or Position: CREDENTIALING
Credential:
Phone: 877-667-7669