Healthcare Provider Details

I. General information

NPI: 1770711392
Provider Name (Legal Business Name): OMS PHYSICIANS GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 MAIN ST SUITE 240
SOUTHLAKE TX
76092-7625
US

IV. Provider business mailing address

1422 MAIN ST SUITE 240
SOUTHLAKE TX
76092-7625
US

V. Phone/Fax

Practice location:
  • Phone: 817-424-1166
  • Fax:
Mailing address:
  • Phone: 817-424-1166
  • Fax:

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: GREGORY DAVID TAYLOR
Title or Position: OWNER
Credential: DDS, M.D.
Phone: 817-424-1166