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NPI Code Detail

MEDICARE: CRANIAL FACIAL HEALTH LLC

MEDICARE: CRANIAL FACIAL HEALTH LLC
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
1174400000XSpecialist
21223S0112XOral and Maxillofacial Surgery (Dentist)
3207YX0905XOtolaryngology/Facial Plastic Surgery Physician
4204E00000XOral & Maxillofacial Surgery (D.M.D.)

General Provider Information

NPI Number : 1184573826
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRANIAL FACIAL HEALTH LLC
Provider Business Mailing Address
First Line : 1340 MANTLEBROOK DR
Second Line :
City : DESOTO
State : TX
Zip : 75115-2966
Country : US
Telephone Number : 972-679-4828
Fax Number :
Provider Business Practice Location Address
First Line : 601 SUNLAND PARK DR STE 2
Second Line :
City : EL PASO
State : TX
Zip : 79912-5229
Country : US
Telephone Number : 872-215-0361
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : SHANIQUA LEGINGTON
Credential :
Telephone Number : 972-679-4828
Provider Enumeration Date : 01/26/2026
Last Update Date : 06/08/2026

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