Provider Demographics
NPI:1225824758
Name:TARRANT COUNTY ORAL AND MAXILLOFACIAL SURGERY LLC
Entity type:Organization
Organization Name:TARRANT COUNTY ORAL AND MAXILLOFACIAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ISHERPREET
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERGILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:312-451-9563
Mailing Address - Street 1:344 COVE DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5679
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:613 W HARWOOD RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3161
Practice Address - Country:US
Practice Address - Phone:817-268-4108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery