Healthcare Provider Details

I. General information

NPI: 1235440504
Provider Name (Legal Business Name): ORAL AND MAXILLOFACIAL ASSOCIATES OF ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 E BROWN RD SUITE 15
MESA AZ
85213-4213
US

IV. Provider business mailing address

2855 E BROWN RD SUITE 15
MESA AZ
85213-4213
US

V. Phone/Fax

Practice location:
  • Phone: 480-659-5977
  • Fax:
Mailing address:
  • Phone: 480-659-5977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number7957
License Number StateAZ

VIII. Authorized Official

Name: DR. EDWARD HUGH CHRISTENSEN
Title or Position: ORAL AND MAXILLOFACIAL SURGERY
Credential: D.D.S.
Phone: 480-659-5977