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General NPI Number Information
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NPI Number | 1871316968
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Entity Type | Organization
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Legal Business Name | BRAZOS ORAL & FACIAL SURGERY, PA
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 103 BURNETT CT
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City | WACO
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State | TX
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Zip | 76712-3100
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Country | US
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Telephone | 254-399-9925
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Fax | 254-399-9930
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Provider Business Mailing Address
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Address Line | 103 BURNETT CT
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City | WACO
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State | TX
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Zip | 76712-3100
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Country | US
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Telephone | 254-399-9925
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Fax | 254-399-9930
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Authorized Official
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Title or Position | PRACTICE LEADER
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Name | WALTER PATRICK ARMSTRONG JR.
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Credential |
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Telephone | 254-399-9925
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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 |
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License Number State |
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