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General NPI Number Information
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NPI Number | 1174794416
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Entity Type | Organization
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Legal Business Name | WEST FRISCO CENTER OF ORAL SURGERY, PLLC
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 12/29/2016
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Provider Practice Location Address
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Address Line | 2121 PEASE ST MEDICAL ARTS PAVILION, SUITE 314
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City | HARLINGEN
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State | TX
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Zip | 78550
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Country | US
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Telephone | 956-216-7570
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Fax | 956-216-7571
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Provider Business Mailing Address
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Address Line | 2121 PEASE ST MEDICAL ARTS PAVILION, SUITE 314
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City | HARLINGEN
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State | TX
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Zip | 78550
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Country | US
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Telephone | 956-216-7570
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Fax | 956-216-7571
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Authorized Official
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Title or Position | PRESIDENT/ ORAL SURGEON
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Name | DR. OMEL GERARDO CARDENAS
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Credential | D.D.S.
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Telephone | 214-872-4445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 20431
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License Number State | TX
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