SOUTHWEST CENTER FOR ORAL SURGERY, PLLC (NPI# 1407398787) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407398787 |
| Entity Type | Organization |
| Organization Name | SOUTHWEST CENTER FOR ORAL SURGERY, PLLC |
| Other Organization Name | SOUTHWEST ORAL SURGERY |
| Practice Address |
6677 W Thunderbird Rd Suite H120 Glendale AZ 85306-3709 |
| Practice Telephone | 6237925794 |
| Practice Fax Number | 6237925809 |
| Mailing Telephone | 6237925794 |
| Mailing Fax Number | 6237925809 |
| Enumeration Date | 2016-11-17 |
| Last Update Date | 2016-11-17 |
| Authorized Official Name | FAWNE E ROGERS (PRACTICE MANAGER) |
| Authorized Official Telephone | 6237925794 |
| Is Organization Subpart | N |
| 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 |
|---|---|---|---|---|
| 1336689140 | Southwest Center for Oral Surgery, Pllc | Dentist | 4600 E Shea Blvd, #201, Phoenix, AZ 85028-6024 | 2017-02-27 |
| Street Address |
6677 W THUNDERBIRD RD SUITE H120 |
| City | GLENDALE |
| State | AZ |
| Zip Code | 85306-3709 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912904509 | Cecil Cyrus Vaughn IIi | Surgery | 6677 W Thunderbird Rd, G-116, Glendale, AZ 85306-3709 | 2005-06-28 |
| 1639602493 | Kelly Milton, Pllc | Psychiatry & Neurology | 6677 W Thunderbird Rd, Building D, Glendale, AZ 85306 | 2017-04-09 |
| 1376919035 | Neurology Center of Arizona Pllc | Specialist | 6677 W Thunderbird Rd, Bldg D148, Glendale, AZ 85306-3709 | 2015-08-18 |
| 1932537354 | Jon Martinson | Physician Assistant | 6677 W Thunderbird Rd, Suite I - 164, Glendale, AZ 85306-3709 | 2013-10-22 |
| 1972938165 | Az Home Md LLC | Podiatrist | 6677 W Thunderbird Rd, J 171, Glendale, AZ 85306-3709 | 2013-09-06 |
| 1497197677 | John C. Lincoln, LLC | Family Medicine | 6677 W Thunderbird Rd, Ste. A124, Glendale, AZ 85306-3709 | 2013-07-29 |
| 1881039337 | Kimberly Nelson | Physician Assistant | 6677 W Thunderbird Rd, Suite I - 164, Glendale, AZ 85306-3709 | 2013-05-09 |
| 1760755730 | Southwest Center for Oral, Facial and Dental Implant Surgery | Dentist | 6677 W Thunderbird Rd, Suite H120, Glendale, AZ 85306-3709 | 2012-02-21 |
| 1710279658 | Phoenix Medical Group, PC | Clinic/Center | 6677 W Thunderbird Rd, Bldg E, Glendale, AZ 85306-3722 | 2011-05-11 |
| 1063740454 | Natasha Boord | Social Worker | 6677 W Thunderbird Rd, Suite I-164, Glendale, AZ 85306-3709 | 2009-11-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548784648 | Michelle Weissgerber | Registered Nurse | 6640 W Maui Ln, Glendale, AZ 85306 | 2017-07-31 |
| 1427502947 | Az Interact LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 6055 West Caribe Lane, Glendale, AZ 85306 | 2016-08-12 |
| 1649667635 | Richard Moreno Jr. | Physical Therapy Assistant | 6509 W Acapulco Ln, Glendale, AZ 85306 | 2015-04-17 |
| 1568863819 | Alternative Living for You | Assisted Living Facility | 5328 W. Tierra Buena Ln., Glendale, AZ 85306 | 2014-09-05 |
| 1649614561 | Matthew Brownell | Internal Medicine | 5555 W, Thunderbird, Banner Thunderbird Medical Center, Glendale, AZ 85306 | 2013-04-22 |
| 1366736266 | Miles Christenson | Speech-Language Pathologist | 14627 N 60th Ave, Glendale, AZ 85306 | 2011-06-08 |
| 1285928721 | Nathalie Tania Petein-alamshaw | Internal Medicine | 5555 W Thunderbird Road, Glendale, AZ 85306 | 2011-06-01 |
| 1134351869 | William J. Duff | Counselor | 5701 W. Talavi Boulevard, Suite 180, Phoenix, AZ 85306 | 2009-08-13 |
| 1538321369 | Cardiovascular Consultants, Ltd | Non-Pharmacy Dispensing Site | 5422 W. Thunderbird, Suite 8, Glendale, AZ 85306 | 2008-07-02 |
| 1316109143 | Cardiovascular Consultants, Ltd | Non-Pharmacy Dispensing Site | 5620 W. Thunderbird, Suite D3, Glendale, AZ 85306 | 2008-07-02 |
| Find all providers in zip 85306 | ||||
| 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 |
|---|---|---|---|---|
| 1255945366 | Phoenix Wisdom Teeth, LLC | Dentist | 17037 N 43rd Ave # A4a, Glendale, AZ 85308-4026 | 2020-09-04 |
| 1750738555 | Omar Kholaki | Dentist | 3863 Sky View Ln, Glendale, CA 91214-1006 | 2016-05-21 |
| 1891182507 | Armand Keuroghlian | Dentist | 1044 Trafalger Dr, Glendale, CA 91207-1140 | 2015-04-20 |
| 1932518107 | Ara Mirzaians | Dentist | 500 N Central Ave Ste 710, Glendale, CA 91203-3386 | 2014-08-12 |
| 1134567381 | Eric Edward Saiz | Dentist | 6677 W Thunderbird Rd Ste H120, Glendale, AZ 85306-3726 | 2013-06-10 |
| 1376841015 | Christopher P. Mcaboy Dds, LLC | Dentist | 377 W River Woods Pkwy # 120, Glendale, WI 53212-1088 | 2011-03-04 |
| 1508196437 | Peter S Nelson | Dentist | 5750 W Thunderbird Rd Ste H850, Glendale, AZ 85306-4694 | 2009-12-25 |
| 1396868774 | Armond Kotikian | Dentist | 242 N. Glendale Ave, Glendale, CA 91206 | 2007-04-09 |
| 1316081623 | Hamlet Charmahali Garabedian | Dentist | 242 N Glendale Ave, Glendale, CA 91206-4454 | 2007-02-19 |
| 1689725780 | Joseph F Goodsell | Dentist | 1146 N Brand Blvd, Glendale, CA 91202-2504 | 2007-01-15 |
| Find all providers in GLENDALE | ||||
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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.