FACIAL AND ORAL SURGERY ASSOCIATES, PLLC (NPI# 1891918827) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891918827 |
| Entity Type | Organization |
| Organization Name | FACIAL AND ORAL SURGERY ASSOCIATES, PLLC |
| Practice Address |
1625 Saint Louis Ave Fort Worth TX 76104-7635 |
| Practice Telephone | 8179271325 |
| Practice Fax Number | 8179271497 |
| Mailing Telephone | 8179271325 |
| Mailing Fax Number | 8179271497 |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2014-01-15 |
| Authorized Official Name | JOHN P. STELLA (PRESIDENT) |
| Authorized Official Telephone | 8179271325 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0106X |
Dentist Specialization: Oral and Maxillofacial Pathology |
Dental Providers | ||
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 009690101 | 05 | |
| TX | BCBS-BLUE LINK | 8116093 | 01 |
| Street Address |
1625 SAINT LOUIS AVE |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76104-7635 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831679836 | Joshua Hockaday | Physician Assistant | 1625 Saint Louis Ave, Fort Worth, TX 76104-7635 | 2018-08-19 |
| 1316180821 | Siavash Eftekhari | Oral & Maxillofacial Surgery | 1625 Saint Louis Ave, Fort Worth, TX 76104-7635 | 2009-04-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669082186 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 1115 8th St, Fort Worth, TX 76104 | 2020-08-10 |
| 1992343693 | Iris Giove | Psychologist | John Peter Smith Hospital, 1500 S. Main St., Fort Worth, TX 76104 | 2019-12-13 |
| 1104480656 | Swarnalaxmi Umapathy | Student in an Organized Health Care Education/Training Program | 900 8th Avenue, Fort Worth, TX 76104 | 2019-04-30 |
| 1881189132 | Mega Surgical Assistants LLC | Specialist/Technologist, Other | 1301pennsylvania, Fort Worth, TX 76104 | 2018-06-28 |
| 1356848899 | Tricia Kelly | Nurse Practitioner | 1325 Pennsylvania Avenue Suite 560, Fort Worth, TX 76104 | 2018-04-11 |
| 1952820979 | Modern Vein Clinic | Internal Medicine | 757 8th Avenue, Suite A, Forth Worth, TX 76104 | 2017-09-11 |
| 1790207165 | Vanessa Abbood | Dietitian, Registered | 900 Eighth Ave, Fns Department, Fort Worth, TX 76104 | 2017-07-07 |
| 1922537562 | Nicole Marie Tod | Student in an Organized Health Care Education/Training Program | 1500 S Main Street, Fort Worth, TX 76104 | 2017-06-07 |
| 1770025934 | Micah Bonola | Chiropractor | 1300 W. Rosedale St, Ste. A, Fort Worth, TX 76104 | 2016-11-04 |
| 1518315894 | United Bioscience, LLC. | Clinical Medical Laboratory | 901 W. Leuda St., B, Fort Worth, TX 76104 | 2016-05-27 |
| Find all providers in zip 76104 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134720337 | Texas Wisdom Teeth Specialists | Dentist | 8409 W Cleburne Rd, Fort Worth, TX 76123-1421 | 2020-11-04 |
| 1699155507 | Implants and Oral Surgery, PC | Dentist | 7217 Hawkins View Dr Ste 200, Fort Worth, TX 76132-3928 | 2015-06-05 |
| 1386058584 | Keith Sonneveld | Dentist | 4421 Oak Park Ln Ste 101, Fort Worth, TX 76109-9541 | 2014-06-16 |
| 1598968190 | Herman Kao | Dentist | 1625 Saint Louis Ave., Fort Worth, TX 76104 | 2007-06-09 |
| 1215130810 | Fayette Creed Williams | Dentist | 1625 Saint Louis Avenue, House Staff & Gme, Fort Worth, TX 76104 | 2007-06-09 |
| 1235353301 | Robert Peak | Dentist | 900 Jerome St, Suite 140, Fort Worth, TX 76104-3945 | 2007-04-12 |
| 1972614071 | Spielman Peak Lois & Humes Dds Ms Inc. | Dentist | 7217 Hawkins View Dr, Suite 200, Fort Worth, TX 76132-3927 | 2006-08-31 |
| 1225070030 | Gregory Blaine Scheideman | Dentist | 4300 Oak Park Ln, Fort Worth, TX 76109-1512 | 2006-06-13 |
| 1508805516 | Joseph Carl Cecere | Dentist | 2501 Ridgmar Plz, Suite 108, Fort Worth, TX 76116-2689 | 2006-06-05 |
| 1538156658 | Max Gregory Neill | Dentist | 4421 Oak Park Ln, Ste 101, Fort Worth, TX 76109-9541 | 2005-10-04 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76104 |
Please comment or provide details below to improve the information on FACIAL AND ORAL SURGERY ASSOCIATES, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.