MEDICARE: CENTRAL TX ORAL & MAXILLOFACIAL SURGERY

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)	17564	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730369299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL TX ORAL & MAXILLOFACIAL SURGERY

Provider Business Mailing Address
First Line	:	2030 HEIGHTS DR STE 3
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2185
Country	:	US
Telephone Number	:	254-699-9500
Fax Number	:	254-699-2796

Provider Business Practice Location Address
First Line	:	2030 HEIGHTS DR STE 3
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2185
Country	:	US
Telephone Number	:	254-699-9500
Fax Number	:	254-699-2796

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. LAVELLE FORD
Credential	:	D.D.S
Telephone Number	:	254-699-9500

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	06/22/2012

Similar Medicare Providers

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Directions to “CENTRAL TX ORAL & MAXILLOFACIAL SURGERY ” Practice Location

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