| East Texas Oral & Maxillofacial Surgery Associates Inc. | |
|
3004 H G Moseley Pkwy Longview TX 75605-2948 | |
| (903) 758-3444 | |
| (903) 758-1967 |
| Full Name | East Texas Oral & Maxillofacial Surgery Associates Inc. |
|---|---|
| Speciality | Dentist |
| Location | 3004 H G Moseley Pkwy, Longview, Texas |
| Authorized Official Name and Position | Charlotte Marie Wilks (OFFICE MANAGER) |
| Authorized Official Contact | 9037583444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Texas Oral & Maxillofacial Surgery Associates Inc. 3004 H G Moseley Pkwy Longview TX 75605-2948 Ph: (903) 758-3444 | East Texas Oral & Maxillofacial Surgery Associates Inc. 3004 H G Moseley Pkwy Longview TX 75605-2948 Ph: (903) 758-3444 |
| NPI Number | 1952459307 |
|---|---|
| Provider Enumeration Date | 01/08/2007 |
| Last Update Date | 03/20/2012 |
| Medicare PECOS PAC ID | 4981865771 |
|---|---|
| Medicare Enrollment ID | O20120423000603 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952459307 | NPI | - | NPPES |
| 111312801 | Medicaid | TX | |
| 111312802 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 10700 (Texas) | Primary |
| Provider Name | James A Mack |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1073606281 PECOS PAC ID: 1052572849 Enrollment ID: I20120423000685 |
| Provider Name | Christopher J Johnson |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1760828370 PECOS PAC ID: 9133362650 Enrollment ID: I20130903000513 |
| Provider Name | Simon L Mack |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1639676166 PECOS PAC ID: 4082001524 Enrollment ID: I20220502000042 |
| Provider Name | Nathan Yang |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1679935076 PECOS PAC ID: 2062809510 Enrollment ID: I20220502000480 |
Pediatric Dental Associates, Llp Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 5 Doctor Cir, Longview, TX 75605 Phone: 903-758-6406 Fax: 903-758-8116 | |
Longview Family And Emergancy Dental Care Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2840 Bill Owens Pkwy Ste B, Longview, TX 75605 Phone: 704-582-2272 | |
East Tx Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2414 Gilmer Rd, Longview, TX 75604 Phone: 903-242-8594 Fax: 903-282-1405 | |