MEDICARE: ONSITE TEXAS ORAL SURGERY SERVICES

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)	19590	TX

General Provider Information

NPI Number	:	1942625967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONSITE TEXAS ORAL SURGERY SERVICES

Provider Business Mailing Address
First Line	:	14856 PRESTON RD
Second Line	:	#104
City	:	DALLAS
State	:	TX
Zip	:	75254-6822
Country	:	US
Telephone Number	:	214-334-8416
Fax Number	:	972-960-1110

Provider Business Practice Location Address
First Line	:	14856 PRESTON RD
Second Line	:	#104
City	:	DALLAS
State	:	TX
Zip	:	75254-6822
Country	:	US
Telephone Number	:	214-334-8416
Fax Number	:	972-960-1110

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT A. WEINSTEIN
Credential	:	DDS, MS
Telephone Number	:	214-693-9217

Provider Enumeration Date	:	02/27/2014
Last Update Date	:	02/27/2014

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