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General NPI Number Information
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NPI Number | 1831324540
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Entity Type | Organization
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Legal Business Name | CAPITAL ORAL AND MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 05/26/2009
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Provider Practice Location Address
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Address Line | 15901 CENTRAL COMMERCE DR STE 601
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-2047
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Country | US
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Telephone | 512-989-7855
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Fax | 512-989-7859
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Provider Business Mailing Address
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Address Line | 15901 CENTRAL COMMERCE DR STE 601
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-2047
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Country | US
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Telephone | 512-989-7855
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Fax | 512-989-7859
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Authorized Official
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Title or Position | OWNER
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Name | MARC RYAN SMITH
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Credential | DDS
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Telephone | 512-989-7855
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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 | 19812
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License Number State | TX
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