Provider Demographics
NPI:1699133801
Name:EL PASO ORAL SURGERY CENTER, PLLC
Entity type:Organization
Organization Name:EL PASO ORAL SURGERY CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:GULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-992-3873
Mailing Address - Street 1:6421 SARATOGA BLVD
Mailing Address - Street 2:BLDG 101
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414
Mailing Address - Country:US
Mailing Address - Phone:361-992-3873
Mailing Address - Fax:361-992-7328
Practice Address - Street 1:7878 GATEWAY BLVD EAST
Practice Address - Street 2:SUITE 301
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915
Practice Address - Country:US
Practice Address - Phone:361-992-3873
Practice Address - Fax:361-992-7328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty