ORAL & MAXILLOFACIAL SURGERY OF TYLER PC NPI 1154493922

NPI Information

ORAL & MAXILLOFACIAL SURGERY OF TYLER, PC is an oral and maxillofacial surgery dentist in Tyler, TX. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. ORAL & MAXILLOFACIAL SURGERY OF TYLER, PC NPI is 1154493922. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Olympic Plaza Oral & Maxillofacial Surgery Assoc..

The provider's business location address is:

700 OLYMPIC PLAZA CIR STE 412
TYLER, TX
ZIP 75701-952
Phone: (903) 595-5186
Fax: (903) 595-5240

The provider's authorized official is Jerri G. Grace .
The authorized official title is Office Manager and has the following contact phone number (903) 595-5186.

The enumeration date for this NPI number is 11/15/2006 and was last updated on 7/16/2008.

Taxonomy Codes

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Other Identifiers

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