Provider Demographics
NPI:1992243976
Name:SAN ANTONIO ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:SAN ANTONIO ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAZOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-696-7500
Mailing Address - Street 1:5282 MEDICAL DR
Mailing Address - Street 2:SUITE # 316
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6044
Mailing Address - Country:US
Mailing Address - Phone:210-696-7500
Mailing Address - Fax:210-692-0248
Practice Address - Street 1:4025 E SOUTHCROSS BLVD
Practice Address - Street 2:BUILDING 1, SUITE #5
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3641
Practice Address - Country:US
Practice Address - Phone:210-337-8600
Practice Address - Fax:210-337-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193671223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty