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General NPI Number Information
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NPI Number | 1891918827
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Entity Type | Organization
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Legal Business Name | FACIAL AND ORAL SURGERY ASSOCIATES, PLLC
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 1625 SAINT LOUIS AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-7635
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Country | US
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Telephone | 817-927-1325
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Fax | 817-927-1497
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Provider Business Mailing Address
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Address Line | 1625 SAINT LOUIS AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-7635
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Country | US
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Telephone | 817-927-1325
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Fax | 817-927-1497
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN P. STELLA
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Credential | DDS
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Telephone | 817-927-1325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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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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