MEDICARE: TEXAS JAW & JOINT PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	10468	TX

General Provider Information

NPI Number	:	1053859918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS JAW & JOINT PLLC

Provider Business Mailing Address
First Line	:	4185 TECHNOLOGY FOREST BLVD
Second Line	:	SUITE 100
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-2006
Country	:	US
Telephone Number	:	713-566-0806
Fax Number	:

Provider Business Practice Location Address
First Line	:	4185 TECHNOLOGY FOREST BLVD
Second Line	:	SUITE 100
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-2006
Country	:	US
Telephone Number	:	713-566-0806
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MARTIN JAMES CLARK
Credential	:
Telephone Number	:	713-254-8010

Provider Enumeration Date	:	02/10/2017
Last Update Date	:	02/10/2017

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