Organization Name: | LAKE TRAVIS ORAL & MAXILLOFACIAL SURGERY, PLLC. |
NPI Number: | 1225321565 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JEFFREY A. ALFORD (PRESIDENT) |
Mailing Address: | 1921 Lohmans Crossing Suite 208 Lakeway |
State: | TX US |
Postal Code: | 787345282 |
Phone Number: | 5122616900 |
Fax Number: | 5125320303 |
NPI Enumeration Date: | 05/19/2011 |
NPI Last Update Date: | 05/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204E00000X |
License Number: | 21279 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Oral & Maxillofacial Surgery |
Taxonomy Specialization: | |
Taxonomy Definition: |