Provider Demographics
NPI:1992942387
Name:ASSOCIATE IN ORAL & IMPLANT SURGERY
Entity type:Organization
Organization Name:ASSOCIATE IN ORAL & IMPLANT SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:F
Authorized Official - Last Name:DUVERNOIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-581-7800
Mailing Address - Street 1:7211 NORTH MESA
Mailing Address - Street 2:STE 1-SOUTH
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912
Mailing Address - Country:US
Mailing Address - Phone:915-581-7800
Mailing Address - Fax:915-587-8995
Practice Address - Street 1:7211 NORTH MESA
Practice Address - Street 2:STE 1-SOUTH
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912
Practice Address - Country:US
Practice Address - Phone:915-581-7800
Practice Address - Fax:915-587-8995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty