Southwest Center for Oral Surgery, PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D8077 Issued in AZ

Legal business name

SOUTHWEST CENTER FOR ORAL SURGERY, PLLC

Practice address

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

Phone

(623) 792-5794

Fax

(623) 792-5809

NPI assigned

Feb 27, 2017

Organization subpart

Yes

Parent organization

SOUTHWEST CENTER FOR ORAL SURGERY, PLLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Fawne Rogers

Title

Practice Manager

Phone

(623) 792-5794

Specialties & licenses 3

Addresses

Other names 1

• Southwest Oral Surgery Doing business as

Tax ID family

Southwest Center for Oral Surgery PLLC2 organizations share this tax ID, including this one

Part of

Southwest Center for Oral Surgery PLLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Southwest Center for Oral Surgery, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Glendale, AZ
  • NPI 1407398787
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Southwest Center for Oral Surgery, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Glendale, AZ
  • NPI 1407398787
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488153600000",
    "number": "1336689140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6677 W THUNDERBIRD RD STE H120",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853063726",
            "telephone_number": "623-792-5794",
            "fax_number": "623-792-5809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 E SHEA BLVD",
            "address_2": "#201",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850286024",
            "telephone_number": "623-792-5794",
            "fax_number": "623-792-5809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST CENTER FOR ORAL SURGERY, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHWEST CENTER FOR ORAL SURGERY, PLLC",
        "enumeration_date": "2017-02-27",
        "last_updated": "2017-02-27",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "FAWNE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "623-792-5794",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "D8077",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "D9133",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "D3178",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Oral and Maxillofacial Surgery (Dentist) in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.