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General NPI Number Information
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NPI Number | 1942685276
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Entity Type | Organization
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Legal Business Name | BRAZOS ORAL & MAXILLOFACIAL SURGERY, PLLC
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 10605 SPRING GREEN BLVD SUITE 200
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City | KATY
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State | TX
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Zip | 77494-4048
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Country | US
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Telephone | 281-394-2933
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Fax | 281-715-4440
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Provider Business Mailing Address
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Address Line | 10605 SPRING GREEN BLVD SUITE 200
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City | KATY
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State | TX
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Zip | 77494-4048
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Country | US
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Telephone | 281-394-2933
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Fax | 281-715-4440
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Authorized Official
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Title or Position | MEMBER/OWNER/ORAL SURGEON
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Name | DR. JAMES WILLIS PLEDGER II
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Credential | DDS
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Telephone | 281-394-2933
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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 | 23859
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License Number State | TX
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