Provider Demographics
NPI:1194931303
Name:BRAZOS VALLEY OMS PLLC
Entity type:Organization
Organization Name:BRAZOS VALLEY OMS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:979-764-7101
Mailing Address - Street 1:1505 EMERALD PLAZA
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-1501
Mailing Address - Country:US
Mailing Address - Phone:979-764-7101
Mailing Address - Fax:979-764-7115
Practice Address - Street 1:1505 EMERALD PLAZA
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-1501
Practice Address - Country:US
Practice Address - Phone:979-764-7101
Practice Address - Fax:979-764-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10404122300000X, 1223S0112X
TX104601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN813315OtherUNITED CONCORDIA
TX00L22LMedicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER