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General NPI Number Information
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NPI Number | 1417002171
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Entity Type | Organization
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Legal Business Name | VICTORIA ORAL & MAXILLOFACIAL SURGERY ASSOCIATES INC,
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 03/01/2011
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Provider Practice Location Address
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Address Line | 111 PROFESSIONAL PARK DR
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City | VICTORIA
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State | TX
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Zip | 77904-2351
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Country | US
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Telephone | 361-578-0247
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Fax |
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Provider Business Mailing Address
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Address Line | 111 PROFESSIONAL PARK DR
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City | VICTORIA
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State | TX
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Zip | 77904-2351
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Country | US
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Telephone | 361-578-0247
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Fax |
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Authorized Official
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Title or Position | ORAL AND MAXILLOFACIAL SURGEON
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Name | DR. THOMAS BARTON CARTER
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Credential | DDS,MS
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Telephone | 361-578-0247
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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 | 17693
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License Number State | TX
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