| Georgetown Center of Oral and Maxillofacial Surgery | |
|
2021 Kauffman Loop Ste 130 Georgetown TX 78628 | |
| (512) 777-0009 | |
| (512) 777-5009 |
| Full Name | Georgetown Center of Oral and Maxillofacial Surgery |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 2021 Kauffman Loop Ste 130, Georgetown, Texas |
| Authorized Official Name and Position | Marion Ugochukwu Harris (OWNER) |
| Authorized Official Contact | 5127770009 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Georgetown Center of Oral and Maxillofacial Surgery 2021 Kauffman Loop Ste 130 Georgetown TX 78628 Ph: (512) 777-0009 | Georgetown Center of Oral and Maxillofacial Surgery 2021 Kauffman Loop Ste 130 Georgetown TX 78628 Ph: (512) 777-0009 |
| NPI Number | 1457246779 |
|---|---|
| Provider Enumeration Date | 06/09/2025 |
| Last Update Date | 06/09/2025 |
| Certification Date | 05/25/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457246779 | NPI | - | NPPES |
| T1093 | Other | TX | TEXAS MEDICAL LICENSE |
| 36909 | Other | TX | TEXAS DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | () | Primary |
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