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ORAL & FACIAL SURGERY CENTER PA NPI 1891744462


NPI Information

NPI: 1891744462
Provider Name: ORAL & FACIAL SURGERY CENTER PA

Former Legal Business Name: MAXILLOFACIAL SURGERY CENTER

Classification: Dentist - 1223S0112X
Entity Type: Organization

Specialization: Oral and Maxillofacial Surgery

Address:
3996 N FRONTAGE RD
FAYETTEVILLE, AR
ZIP 72703
Phone: (479) 582-3002
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ORAL & FACIAL SURGERY CENTER PA is an oral and maxillofacial surgery dentist in Fayetteville, AR. The provider is an oral and maxillofacial surgery dentist specialized in 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. ORAL & FACIAL SURGERY CENTER PA NPI is 1891744462. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Former Legal Business Name Is Maxillofacial Surgery Center.

The provider's business location address is:

3996 N FRONTAGE RD
FAYETTEVILLE, AR
ZIP 72703-122
Phone: (479) 582-3002
Fax: (479) 582-2840

The provider's authorized official is Scotty L Bolding .
The authorized official title is Owner and has the following contact phone number (479) 957-4611.

The enumeration date for this NPI number is 5/9/2006 and was last updated on 6/7/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1204E00000XOral & Maxillofacial SurgeryNo
21223S0112XDentistOral and Maxillofacial SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1127319680MEDICAIDARKANSAS
2230273680MEDICAIDARKANSAS
3239128680MEDICAIDARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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