Provider Demographics
NPI:1871316968
Name:BRAZOS ORAL & FACIAL SURGERY, PA
Entity type:Organization
Organization Name:BRAZOS ORAL & FACIAL SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE LEADER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:254-399-9925
Mailing Address - Street 1:103 BURNETT CT
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3100
Mailing Address - Country:US
Mailing Address - Phone:254-399-9925
Mailing Address - Fax:254-399-9930
Practice Address - Street 1:103 BURNETT CT
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3100
Practice Address - Country:US
Practice Address - Phone:254-399-9925
Practice Address - Fax:254-399-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty