Healthcare Provider Details

I. General information

NPI: 1508758657
Provider Name (Legal Business Name): ORAL FACIAL SURGERY INSTITUTE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 E BROWN RD STE 5
MESA AZ
85213-4214
US

IV. Provider business mailing address

2604 E PAGE AVE
GILBERT AZ
85234-6311
US

V. Phone/Fax

Practice location:
  • Phone: 480-659-5977
  • Fax: 480-219-0971
Mailing address:
  • Phone: 503-568-0507
  • Fax:

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. SAVANNAH WEEDMAN
Title or Position: DIRECTOR
Credential: DDS, MD
Phone: 503-568-0507