Provider Demographics
NPI:1487533428
Name:MIDLAND ORAL & MAXILLOFACIAL SURGERY PA
Entity type:Organization
Organization Name:MIDLAND ORAL & MAXILLOFACIAL SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:432-262-0704
Mailing Address - Street 1:2701 W CUTHBERT AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3819
Mailing Address - Country:US
Mailing Address - Phone:432-262-0704
Mailing Address - Fax:432-694-5815
Practice Address - Street 1:2701 W CUTHBERT AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3819
Practice Address - Country:US
Practice Address - Phone:432-262-0704
Practice Address - Fax:432-694-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery