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27866 Interstate 45 N C Conroe TX 77385-8725 | |
| (281) 681-2700 | |
| (281) 296-8498 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 27866 Interstate 45 N, Conroe, Texas |
| Authorized Official Name and Position | Mary Boney (DIR HR/PROFESSIONAL RELATIONS) |
| Authorized Official Contact | 2812968600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
26615 Oak Ridge Dr The Woodlands TX 77380-1968 Ph: (281) 296-8600 | 27866 Interstate 45 N C Conroe TX 77385-8725 Ph: (281) 681-2700 |
| NPI Number | 1114030178 |
|---|---|
| Provider Enumeration Date | 08/16/2006 |
| Last Update Date | 08/29/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114030178 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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