| Oral & Maxillofacial Network, P.l.l.c. | |
|
1500 S Main St Fort Worth TX 76104-4917 | |
| (817) 920-6936 | |
| (817) 702-1035 |
| Full Name | Oral & Maxillofacial Network, P.l.l.c. |
|---|---|
| Speciality | Dentist |
| Location | 1500 S Main St, Fort Worth, Texas |
| Authorized Official Name and Position | Holly Marie Portwood (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 8179206936 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oral & Maxillofacial Network, P.l.l.c. 1500 S Main St Fort Worth TX 76104-4917 Ph: (817) 920-6936 | Oral & Maxillofacial Network, P.l.l.c. 1500 S Main St Fort Worth TX 76104-4917 Ph: (817) 920-6936 |
| NPI Number | 1417170655 |
|---|---|
| Provider Enumeration Date | 04/10/2007 |
| Last Update Date | 07/08/2024 |
| Medicare PECOS PAC ID | 2668498387 |
|---|---|
| Medicare Enrollment ID | O20051021000045 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417170655 | NPI | - | NPPES |
| 180717401 | Medicaid | TX | |
| G60225-01 | Other | TX | TX CHIP DELTA DENTAL |
| 48MZ | Other | TX | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | (* (Not Available)) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | John P Stella |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1114992757 PECOS PAC ID: 7719933167 Enrollment ID: I20051025000111 |
| Provider Name | Michael R Warner |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1730154378 PECOS PAC ID: 8022916212 Enrollment ID: I20051025000134 |
| Provider Name | Herman Kao |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1598968190 PECOS PAC ID: 8921155813 Enrollment ID: I20090410000063 |
| Provider Name | Fayette C Williams |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1215130810 PECOS PAC ID: 4688706849 Enrollment ID: I20100723000312 |
| Provider Name | Roderick Kim |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1689954562 PECOS PAC ID: 5698081347 Enrollment ID: I20170805000004 |
| Provider Name | Michael L Winstead |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1245650613 PECOS PAC ID: 4082915541 Enrollment ID: I20210804001759 |
| Provider Name | Jonathan Jelmini |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1477000164 PECOS PAC ID: 3577813328 Enrollment ID: I20220705002936 |
| Provider Name | David Michael Schwitzer |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1285167544 PECOS PAC ID: 0244696672 Enrollment ID: I20230510000301 |
Miles Dental Care Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6263 Mccart Ave, 201, Fort Worth, TX 76133 Phone: 817-370-1314 Fax: 817-370-1344 | |
Country Day Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 4255 Bryant Irvin Rd, Suite 111, Fort Worth, TX 76109 Phone: 817-731-9487 Fax: 817-731-2846 | |
Seminary Family Dental Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 546 W Seminary Dr, Suite # C, Fort Worth, TX 76115 Phone: 817-924-0091 | |
Abc Family Dental Dental Clinic Medicare: Medicare Enrolled Practice Location: 5416 Basswood Blvd, Fort Worth, TX 76137 Phone: 817-656-1215 Fax: 877-230-8349 | |
Fred L. Spradley, D.d.s., M.s.d., P.a. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 4763 Barwick Dr, Suite 107, Fort Worth, TX 76132 Phone: 817-294-5021 Fax: 817-294-9310 | |
J. Walton Lawrence, Jr., D.d.s., Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2512 Horne St Ste C, Fort Worth, TX 76107 Phone: 817-737-6601 Fax: 817-737-6446 | |
Michaelangelo Dentistry Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2417 Park Hill Dr # 119, Fort Worth, TX 76110 Phone: 817-926-9771 |