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

6677 W Thunderbird Rd
Suite H120
Glendale, AZ 85306-3709

Phone

(623) 792-5794

Fax

(623) 792-5809

NPI assigned

Nov 17, 2016

Organization subpart

No

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

Authorized official

Name

Fawne E 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

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)
  • Phoenix, AZ
  • NPI 1336689140
  NPD tax ID

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Southwest Center for Oral Surgery, PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Phoenix, AZ
  • NPI 1336689140
  NPPES parent name

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

{
    "created_epoch": "1479340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479340800000",
    "number": "1407398787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6677 W THUNDERBIRD RD",
            "address_2": "SUITE H120",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853063709",
            "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": "6677 W THUNDERBIRD RD",
            "address_2": "SUITE H120",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853063709",
            "telephone_number": "623-792-5794",
            "fax_number": "623-792-5809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST CENTER FOR ORAL SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-17",
        "last_updated": "2016-11-17",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "FAWNE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "623-792-5794"
    },
    "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"
        }
    ]
}

• Nevaeh Sotelo
• Allison Ann Soto
• Carlos T Soto, DPT
• Sandra Carolina Soto, FNP-C
• Soul and Body Wellness
• Southwest Center for Oral, Facial and Dental Implant Surgery
• Southwest Foot Institute Inc
• Southwest Foot Institute Inc
• Southwest Kidney Davita Dialysis Partners LLC
• Southwest Kidney Davita Dialysis Partners LLC

• Oral and Maxillofacial Surgery (Dentist) in Glendale, AZ
• Providers in Glendale, 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 Nov 17, 2016; 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.