WEST TEXAS MAXILLOFACIAL SURGERY PA
Medical Practice at Gateway Blvd, El Paso, TX

License number
Texas 25153
Category
Medical Practice
Type
Oral & Maxillofacial Surgery
Owner
Name: VERNON P BURKE DMD
Title: DIRECTOR
Phone: (210) 630-9909
Address
Address
10175 Gateway Blvd W SUITE304, El Paso, TX 79925
National Provider ID: 1700178555
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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WEST TEXAS MAXILLOFACIAL SURGERY, PA

El Paso, TX

Status:
Inactive
Industry:
Medical Doctor's Office
Doing business as:
WEST TEXAS MAXILLOFACIAL SURGERY<br>West Texas Maxillofacial Surgery, PA
Registration:
Mar 28, 2011
Phone:
(915) 504-6880 (Phone)
Addresses:
10175 Gtwy Blvd W #304, El Paso, TX 79925 (Mailing)
100 N Stanton St, El Paso, TX 79901
State ID:
0801403895
Business type:
Professional Association
Director, Member, President, Secretary, Treasurer, Vice-President, Family And General Dentistry, Medical Doctor, Owners:
Ryan Q. Green (Md Dds),Vernon P. Burke Director, Member, President, Secretary, Treasurer, Vice-President, Family And General Dentistry, Medical Doctor, Owner, inactive
Agent:
Clyde A Pine Jr,100 N Stanton SUITE 1000, El Paso, TX 79901 (Physical)
TIN:
32043918401
Categories:
Plastic & Reconstructive Surgery

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