Provider Demographics
NPI:1528249505
Name:ORAL AND MAXILLOFACIAL SURGEONS, SW, PC
Entity type:Organization
Organization Name:ORAL AND MAXILLOFACIAL SURGEONS, SW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:V
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-242-2848
Mailing Address - Street 1:3501 TOWN CENTER BLVD S
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1285
Mailing Address - Country:US
Mailing Address - Phone:281-242-2848
Mailing Address - Fax:281-242-9172
Practice Address - Street 1:3501 TOWN CENTER BLVD S
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1285
Practice Address - Country:US
Practice Address - Phone:281-242-2848
Practice Address - Fax:281-242-9172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty