Provider Demographics
NPI:1174794416
Name:WEST FRISCO CENTER OF ORAL SURGERY, PLLC
Entity type:Organization
Organization Name:WEST FRISCO CENTER OF ORAL SURGERY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:OMEL
Authorized Official - Middle Name:GERARDO
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-872-4445
Mailing Address - Street 1:2121 PEASE ST
Mailing Address - Street 2:MEDICAL ARTS PAVILION, SUITE 314
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550
Mailing Address - Country:US
Mailing Address - Phone:956-216-7570
Mailing Address - Fax:956-216-7571
Practice Address - Street 1:2121 PEASE ST
Practice Address - Street 2:MEDICAL ARTS PAVILION, SUITE 314
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550
Practice Address - Country:US
Practice Address - Phone:956-216-7570
Practice Address - Fax:956-216-7571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204311223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty