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General NPI Number Information
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NPI Number | 1740423011
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Entity Type | Organization
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Legal Business Name | BEDFORD ASSOC IN ORAL&MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 04/15/2009
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Last Update Date | 04/15/2009
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Provider Practice Location Address
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Address Line | 2121 CENTRAL DR STE 1
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City | BEDFORD
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State | TX
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Zip | 76021-5885
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Country | US
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Telephone | 817-283-5581
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Fax | 817-283-8650
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Provider Business Mailing Address
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Address Line | 2121 CENTRAL DR STE 1
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City | BEDFORD
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State | TX
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Zip | 76021-5885
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Country | US
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Telephone | 817-283-5581
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Fax | 817-283-8650
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN P MCPHILLIPS
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Credential | DDS, MD
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Telephone | 817-283-5581
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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 | 24440
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License Number State | TX
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