Provider Demographics
NPI:1871800458
Name:COASTAL BEND ORAL & FACIAL SURGERY, PA
Entity type:Organization
Organization Name:COASTAL BEND ORAL & FACIAL SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TEENIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-814-3223
Mailing Address - Street 1:4210 WEBER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-3665
Mailing Address - Country:US
Mailing Address - Phone:361-814-3223
Mailing Address - Fax:
Practice Address - Street 1:4210 WEBER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-3665
Practice Address - Country:US
Practice Address - Phone:361-814-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty