Organization
SOUTHWEST CENTER FOR ORAL SURGERY, PLLC
Active
Other names
Southwest Oral Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
FAWNE E ROGERS (PRACTICE MANAGER)
(623) 792-5794
Entity
Organization
Contact information
Practice address
6677 W THUNDERBIRD RD, SUITE H120, GLENDALE, AZ 85306-3709
(623) 792-5794
(623) 792-5809
Mailing address
6677 W THUNDERBIRD RD, SUITE H120, GLENDALE, AZ 85306-3709
(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
11/17/2016
Last updated
11/17/2016
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