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General NPI Number Information
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NPI Number | 1912185703
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Entity Type | Organization
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Legal Business Name | TRINITY VALLEY ORAL SURGERY & DENTAL IMPLANT CENTER
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 215 S. FM 548 SUITE C
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City | FORNEY
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State | TX
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Zip | 75126
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Country | US
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Telephone | 469-689-0704
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Fax | 469-689-0709
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Provider Business Mailing Address
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Address Line | 215 S. FM 548 SUITE C
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City | FORNEY
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State | TX
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Zip | 75126
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Country | US
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Telephone | 469-689-0704
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Fax | 469-689-0709
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM RALPH PHILLIPS
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Credential | MD
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Telephone | 469-689-0704
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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 | 19017
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License Number State | TX
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