Provider Demographics
NPI:1053762823
Name:KATY CENTER FOR ORAL AND FACIAL SURGERY
Entity type:Organization
Organization Name:KATY CENTER FOR ORAL AND FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IMPASTATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-392-1130
Mailing Address - Street 1:23922 CINCO VILLAGE CENTER BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6619
Mailing Address - Country:US
Mailing Address - Phone:281-392-1130
Mailing Address - Fax:
Practice Address - Street 1:23922 CINCO VILLAGE CENTER BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6619
Practice Address - Country:US
Practice Address - Phone:281-392-1130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty