Organization
SOUTHWEST CENTER FOR ORAL SURGERY, PLLC
Active
Parent organization
SOUTHWEST CENTER FOR ORAL SURGERY, PLLC
Other names
Southwest Oral Surgery
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHWEST CENTER FOR ORAL SURGERY, PLLC
Authorized official
MRS. FAWNE ROGERS (PRACTICE MANAGER)
(623) 792-5794
Entity
Organization
Contact information
Practice address
4600 E SHEA BLVD, #201, PHOENIX, AZ 85028-6024
(623) 792-5794
(623) 792-5809
Mailing address
6677 W THUNDERBIRD RD STE H120, GLENDALE, AZ 85306-3726
(623) 792-5794
(623) 792-5809
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D3178
AZ
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D8077
AZ
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D9133
AZ
Other
Enumeration date
02/27/2017
Last updated
02/27/2017
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