| The Center For Oral, Facial, And Implant Surgery Pa | |
|
2310 Highway 157 N Suite 103 Mansfield TX 76063-8844 | |
| (817) 477-0922 | |
| (817) 477-0910 |
| Full Name | The Center For Oral, Facial, And Implant Surgery Pa |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 2310 Highway 157 N, Mansfield, Texas |
| Authorized Official Name and Position | Michael Derae Sheppard (PRESIDENT) |
| Authorized Official Contact | 8174770922 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Center For Oral, Facial, And Implant Surgery Pa 2310 Highway 157 N Suite 103 Mansfield TX 76063-8844 Ph: (817) 477-0922 | The Center For Oral, Facial, And Implant Surgery Pa 2310 Highway 157 N Suite 103 Mansfield TX 76063-8844 Ph: (817) 477-0922 |
| NPI Number | 1467694208 |
|---|---|
| Provider Enumeration Date | 03/25/2009 |
| Last Update Date | 03/25/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467694208 | NPI | - | NPPES |
| 8F2168 | Other | TX | MEDICARE ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 21182 (Texas) | Primary |
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