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General NPI Number Information
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NPI Number | 1558770214
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Entity Type | Organization
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Legal Business Name | CAPROCK ORAL SURGERY, PLLC
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 5730 66TH ST
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City | LUBBOCK
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State | TX
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Zip | 79424-1224
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Country | US
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Telephone | 806-794-0001
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Fax | 806-794-0025
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Provider Business Mailing Address
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Address Line | 5730 66TH ST
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City | LUBBOCK
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State | TX
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Zip | 79424-1224
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Country | US
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Telephone | 806-794-0001
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Fax | 806-794-0025
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAMSEY MATTHEW FANOUS
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Credential | D.D.S.
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Telephone | 806-794-0001
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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 | TX16343
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License Number State | TX
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