# SOUTHWEST CENTER FOR ORAL SURGERY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southwest Oral Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407398787
- **Authorized official:** FAWNE E ROGERS (PRACTICE MANAGER)
- **Authorized official phone:** (623) 792-5794

## Contact information

- **Practice address:** 6677 W THUNDERBIRD RD, SUITE H120, GLENDALE, AZ 85306-3709
- **Practice address phone:** (623) 792-5794
- **Practice address fax:** (623) 792-5809
- **Mailing address:** 6677 W THUNDERBIRD RD, SUITE H120, GLENDALE, AZ 85306-3709
- **Mailing address phone:** (623) 792-5794
- **Mailing address fax:** (623) 792-5809

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | D3178 | AZ | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | D8077 | AZ | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | D9133 | AZ | — |

## Other

- **Enumeration date:** 11/17/2016
- **Last updated:** 11/17/2016