Healthcare Provider Details

I. General information

NPI: 1871013524
Provider Name (Legal Business Name): ANTHEM ORAL SURGERY & IMPLANT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42104 N VENTURE DR
ANTHEM AZ
85086-3823
US

IV. Provider business mailing address

30012 N CAVE CREEK RD STE 103
CAVE CREEK AZ
85331-5833
US

V. Phone/Fax

Practice location:
  • Phone: 480-575-0844
  • Fax:
Mailing address:
  • Phone: 480-575-0844
  • Fax: 480-575-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD5779
License Number StateAZ

VIII. Authorized Official

Name: DR. BROWN HARRIS III
Title or Position: SURGEON
Credential:
Phone: 480-575-0844