Healthcare Provider Details

I. General information

NPI: 1669885802
Provider Name (Legal Business Name): YAVAPAI ORAL AND FACIAL SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 E FLORENTINE RD
PRESCOTT VALLEY AZ
86314-8454
US

IV. Provider business mailing address

PO BOX 258848
OKLAHOMA CITY OK
73125-8848
US

V. Phone/Fax

Practice location:
  • Phone: 928-775-2545
  • Fax: 928-775-2535
Mailing address:
  • Phone: 877-667-7669
  • Fax: 405-848-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD008900
License Number StateAZ

VIII. Authorized Official

Name: MRS. KATHY S DRESHER
Title or Position: VP BILLING
Credential:
Phone: 405-848-7974