Healthcare Provider Details

I. General information

NPI: 1659193852
Provider Name (Legal Business Name): ARIZONA CENTER FOR ORAL SURGERY, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18301 N 79TH AVE STE 185
GLENDALE AZ
85308-6093
US

IV. Provider business mailing address

18301 N 79TH AVE STE 185
GLENDALE AZ
85308-6093
US

V. Phone/Fax

Practice location:
  • Phone: 623-931-9197
  • Fax: 623-937-4385
Mailing address:
  • Phone: 623-931-9197
  • Fax: 623-937-4385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DONALD HOAGLIN
Title or Position: PARTNER
Credential: DDS
Phone: 623-931-9197