Organization · Type 2 NPI

Southwest Center for Oral Surgery, PLLC

Oral and Maxillofacial Surgery (Dentist) · Phoenix, AZ

NPI number 1336689140 Active

Practice location

4600 E Shea Blvd, #201
Phoenix, AZ 85028-6024

Call (623) 792-5794 Map

Fax (623) 792-5809

Mailing address

6677 W Thunderbird Rd Ste H120
Glendale, AZ 85306-3726

Specialties and licenses

Taxonomy	Code	License
Oral and Maxillofacial Surgery (Dentist) Primary	1223S0112X	D8077 (AZ)
Oral and Maxillofacial Surgery (Dentist)	1223S0112X	D9133 (AZ)
Oral and Maxillofacial Surgery (Dentist)	1223S0112X	D3178 (AZ)

Oral and Maxillofacial Surgery (Dentist): The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

34 other providers at this address

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NPI record

NPI: 1336689140
Entity type: Organization (Type 2)
Issued: Feb 27, 2017
Last updated: Feb 27, 2017
Status: Active
Subpart: Yes of Southwest Center for Oral Surgery, PLLC

Other names

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Southwest Oral Surgery · doing business as

Authorized official

Mrs. Fawne Rogers
Practice Manager
(623) 792-5794

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1336689140

Southwest Center for Oral Surgery, PLLC's National Provider Identifier is 1336689140, issued on Feb 27, 2017. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in Phoenix, AZ. The record was last updated on Feb 27, 2017.