Healthcare Provider Details

I. General information

NPI: 1023166360
Provider Name (Legal Business Name): ARROWHEAD ORAL & MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18555 N 79TH AVE #A103
GLENDALE AZ
85308-8370
US

IV. Provider business mailing address

18555 N 79TH AVE #A103
GLENDALE AZ
85308-8370
US

V. Phone/Fax

Practice location:
  • Phone: 623-412-0310
  • Fax: 623-412-2188
Mailing address:
  • Phone: 623-412-0310
  • Fax: 623-412-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberD5314
License Number StateAZ

VIII. Authorized Official

Name: DR. MICHAEL G ALLARD
Title or Position: PRESIDENT
Credential: DDS.MD.
Phone: 623-412-0310