Oral & Maxillofacial Network

NPI Provider: 1417170655
Contact Name: Portwood Marie Holly
Position: Manager
Phone: (817) 920-6936

Oral & Maxillofacial Network Information:

Oral & Maxillofacial Network organization have npi 1417170655, taxonomy code is 1223P0106X with license number is in . This Business address located in 1500 S Main St, Fort Worth, TX 76104 Texas.

Practice Location
Address: 1500 S Main St, Fort Worth, TX 76104
Phone: (817) 920-6936

Business Location
Address: 1500 S Main St, Fort Worth, TX 76104
Phone: (817) 920-6936
Fax: (817) 927-1497

Taxonomy

Taxonomy Code: 1223P0106X

License Number:

License Number of State:

Primary Taxonomy Switch: X

Enumeration Date: 4/10/2007

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