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General NPI Number Information
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NPI Number | 1700188372
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Entity Type | Organization
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Legal Business Name | CENTER FOR FACIAL ORAL & IMPLANT SURGERY PA
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Dates
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Enumeration Date | 12/02/2010
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 705 E MARSHALL AVE 4003
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City | LONGVIEW
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State | TX
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Zip | 75601-5573
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Country | US
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Telephone | 903-315-3810
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Fax | 903-315-1937
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Provider Business Mailing Address
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Address Line | 705 E MARSHALL AVE 4003
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City | LONGVIEW
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State | TX
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Zip | 75601
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Country | US
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Telephone | 903-315-3810
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Fax | 903-315-1937
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY P HATZIS
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Credential | DDS, MD
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Telephone | 903-315-3813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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