Oral & Maxillofacial Network, P.L.L.C.
NPI 1417170655ActiveOrganization· Dentist, Oral and Maxillofacial Surgery· Fort Worth, TX
Dentist, Oral and Maxillofacial Surgery in Fort Worth, Texas, registered in NPPES in April 2007. The authorized official on file is Holly Marie Portwood, Chief Operating Officer. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1417170655 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Apr 10, 2007 |
| Last updated in NPPES | Jul 8, 2024 |
| Certified by provider | Jul 8, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, Oral and Maxillofacial Surgery Primary | 1223S0112X | — | — |
| Dentist, Oral and Maxillofacial Pathology | 1223P0106X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (TX) |
|---|
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