SOUTHWEST CENTER FOR ORAL SURGERY, PLLC (NPI# 1336689140) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336689140 |
| Entity Type | Organization |
| Organization Name | SOUTHWEST CENTER FOR ORAL SURGERY, PLLC |
| Other Organization Name | SOUTHWEST ORAL SURGERY |
| Practice Address |
4600 E Shea Blvd #201 Phoenix AZ 85028-6024 |
| Mailing Address |
6677 W Thunderbird Rd Ste H120 Glendale AZ 85306-3726 |
| Practice Telephone | 6237925794 |
| Practice Fax Number | 6237925809 |
| Mailing Telephone | 6237925794 |
| Mailing Fax Number | 6237925809 |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2017-02-27 |
| Authorized Official Name | MRS. FAWNE ROGERS (PRACTICE MANAGER) |
| Authorized Official Telephone | 6237925794 |
| Is Organization Subpart | Y |
| Parent Organization Name | SOUTHWEST CENTER FOR ORAL SURGERY, PLLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
D9133 | AZ | Dental Providers |
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
D3178 | AZ | Dental Providers |
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
D8077 | AZ | Dental Providers |
| Other Name | Type Code |
|---|---|
| Southwest Oral Surgery | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407398787 | Southwest Center for Oral Surgery, Pllc | Dentist | 6677 W Thunderbird Rd, Suite H120, Glendale, AZ 85306-3709 | 2016-11-17 |
| Street Address |
4600 E SHEA BLVD #201 |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85028-6024 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821041344 | Therapy Time | Specialist/Technologist | 4600 E Shea Blvd, Suite 101, Phoenix, AZ 85028-6024 | 2006-05-18 |
| 1265969943 | Kirsten Bethancourt | Physical Therapist | 4600 E Shea Blvd, Suite 101, Phoenix, AZ 85028-6024 | 2017-05-12 |
| 1275064404 | Hannah Brennan | Occupational Therapist | 4600 E Shea Blvd, Suite 101, Phoenix, AZ 85028-6024 | 2017-03-21 |
| 1396287280 | Samantha Bookland Counseling, LLC | Counselor | 4600 E Shea Blvd, Phoenix, AZ 85028-6024 | 2016-11-09 |
| 1285091694 | Ashley Marie Adams | Speech-Language Pathologist | 4600 E Shea Blvd, Suite 101, Phoenix, AZ 85028-6024 | 2016-01-15 |
| 1467825273 | Skylar Elena Stiff | Speech-Language Pathologist | 4600 E Shea Blvd, Unit 101, Phoenix, AZ 85028-6024 | 2015-11-03 |
| 1336524255 | Kellie Wright | Speech-Language Pathologist | 4600 E Shea Blvd, #101, Phoenix, AZ 85028-6024 | 2015-07-21 |
| 1780068387 | Ashley Routh | Physical Therapist | 4600 E Shea Blvd, Phoenix, AZ 85028-6024 | 2015-07-13 |
| 1467832196 | The Clubhouse Innovative Therapy Centers | Clinic/Center | 4600 E Shea Blvd, 101, Phoenix, AZ 85028-6024 | 2015-06-08 |
| 1265824221 | Emily Pierson | Occupational Therapist | 4600 E Shea Blvd, Ste. 101, Phoenix, AZ 85028-6024 | 2015-02-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235626565 | Celice Korsten | Psychologist | 11020 N. Tatum Blvd., Ste. 100, Phoenix, AZ 85028 | 2018-04-23 |
| 1720591605 | Michele Kaplan | Counselor | 11640 N Tatum Blvd #3096, Phoenix, AZ 85028 | 2017-11-14 |
| 1154840304 | Faustino M. Gonzalez, Md PC | Anesthesiology | 11811 N. Tatum Blvd, Suite 3031, Phoenix, AZ 85028 | 2017-09-19 |
| 1679092514 | Savior Palliative Care LLC | Family Medicine | 4530 E Shea Blvd Ste 175, Phoenix, AZ 85028 | 2017-09-12 |
| 1437688892 | Harmony Behavioral Health | Behavioral Analyst | 3008 E Sierra St, Phoenix, AZ 85028 | 2017-06-08 |
| 1275949224 | Alexander D Garza | Podiatrist | 3101 E Shea Blvd Ste 220, Phoenix, AZ 85028 | 2014-07-09 |
| 1720418379 | Alyssa Hale | Occupational Therapy Assistant | 4600 East Shea Boulevard, Suite 101, Phoenix, AZ 85028 | 2013-11-19 |
| 1932534476 | Stephen Howard Garber | Otolaryngology | 9607 N. 43rd Way, Phoenix, AZ 85028 | 2013-09-03 |
| 1366798050 | Irna Lynn Shamos | Clinical Neuropsychologist | 4516 East Onyx Avenue, Arizona Psychological Diagnostics, Plc, Phoenix, AZ 85028 | 2012-07-31 |
| 1285930925 | Cathy Ann Payne | Nurse Practitioner | 11209 N Tatum Blvd Ste 260, Phoenix, AZ 85028 | 2011-01-27 |
| Find all providers in zip 85028 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730681776 | Phoenix Oral and Maxillofacial Surgeons | Dentist | 9515 W Camelback Rd Ste 122, Phoenix, AZ 85037-1365 | 2018-03-06 |
| 1861993040 | Joseph E. Pierse, Dmd, Pllc | Dentist | 2060 W Whispering Wind Dr Ste 167, Phoenix, AZ 85085-2869 | 2018-02-23 |
| 1508253014 | Benjamin Noel Zuniga | Dentist | 3542 W Camelback Rd, Phoenix, AZ 85019 | 2015-04-22 |
| 1730450677 | Aria Dental Center LLC | Dentist | 12320 N 32nd St Ste 2, Phoenix, AZ 85032-7154 | 2012-01-24 |
| 1285873125 | An Elegant Smile P.C. | Dentist | 4550 E Bell Rd Ste 8-178, Phoenix, AZ 85032-9306 | 2009-02-17 |
| 1740486737 | Amogh Velangi | Dentist | 706 E Bell Rd Ste 106, Phoenix, AZ 85022-6641 | 2007-06-26 |
| 1568667061 | Oral & Facial Surgeons of Arizona | Dentist | 5050 N. 40th Street, Suite 180, Phoenix, AZ 85018 | 2007-06-15 |
| 1003038571 | Bogdan Michael Kulikowski | Dentist | 15215 S 48th Street, Suite #158, Phoenix, AZ 85044-9139 | 2007-05-03 |
| 1912121930 | Steven K. Ingersoll Dds PC | Dentist | 10211 N 32nd St Ste A1, Phoenix, AZ 85028-3841 | 2007-04-12 |
| 1144381468 | Reed H. Day | Dentist | 2222 E Highland Ave Ste 320, Phoenix, AZ 85016-4879 | 2006-12-12 |
| Find all providers in PHOENIX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.