Provider Demographics
NPI:1528243094
Name:METROPLEX ORA L AND FACIAL SURGERY
Entity type:Organization
Organization Name:METROPLEX ORA L AND FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUCENTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:972-698-8500
Mailing Address - Street 1:2762 N GALLOWAY AVE
Mailing Address - Street 2:#100
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150
Mailing Address - Country:US
Mailing Address - Phone:972-698-8500
Mailing Address - Fax:972-698-8505
Practice Address - Street 1:2762 N GALLOWAY AVE
Practice Address - Street 2:#100
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:972-698-8500
Practice Address - Fax:972-698-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXI97101223S0112X
1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166622401Medicaid
TX166622401Medicaid