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General NPI Number Information
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NPI Number | 1477540052
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Entity Type | Organization
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Legal Business Name | TEXAS ORAL AND FACIAL SURGERY
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 810 S MASON RD SUITE 301
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City | KATY
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State | TX
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Zip | 77450-3895
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Country | US
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Telephone | 281-395-1200
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Fax | 281-395-1201
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Provider Business Mailing Address
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Address Line | 810 S MASON RD SUITE 301
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City | KATY
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State | TX
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Zip | 77450-3895
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Country | US
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Telephone | 281-395-1200
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Fax | 281-395-1201
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Authorized Official
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Title or Position | DR
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Name | RAYMOND L WIGGINS
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Credential | D.D.S., M.D.
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Telephone | 281-395-1200
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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 | 18986
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License Number State | TX
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