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LIVE OAK ORAL SURGERY OF TEXAS PLLC NPI 1649834680


NPI Information

NPI: 1649834680
Provider Name: LIVE OAK ORAL SURGERY OF TEXAS PLLC
Classification: Dentist - 1223S0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
2708 SOUTHWEST PKWY STE 130
WICHITA FALLS, TX
ZIP 76308
Phone: (580) 699-3131
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LIVE OAK ORAL SURGERY OF TEXAS PLLC is an oral and maxillofacial surgery dentist in Wichita Falls, 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. LIVE OAK ORAL SURGERY OF TEXAS PLLC NPI is 1649834680. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2708 SOUTHWEST PKWY STE 130
WICHITA FALLS, TX
ZIP 76308-735
Phone: (580) 699-3131
Fax: (580) 699-3151

The provider's authorized official is Michael J Gliddon .
The authorized official title is Owner/oral Surgeon and has the following contact phone number (580) 699-3131.

The enumeration date for this NPI number is 4/25/2019 and was last updated on 4/25/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial SurgeryYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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