# FRONTIER ORAL & MAXILLOFACIAL SURGERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215446042
- **Authorized official:** KAMI JO GANUS (REVENUE CYCLE MANAGER)
- **Authorized official phone:** (907) 865-5254

## Contact information

- **Practice address:** 3220 PROVIDENCE DR STE E3-080, ANCHORAGE, AK 99508-4657
- **Practice address phone:** (907) 375-8785
- **Practice address fax:** (907) 375-8788
- **Mailing address:** 3220 PROVIDENCE DRIVE STE E3080, 3220 PROVIDENCE DRIVE STE E3080, ANCHORAGE, AK 99508-4657
- **Mailing address phone:** (907) 375-8785
- **Mailing address fax:** (907) 375-8788

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 09/25/2017
- **Last updated:** 07/21/2022