Healthcare Provider Details

I. General information

NPI: 1992997290
Provider Name (Legal Business Name): SCOTTSDALE SURGICAL ARTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10603 N HAYDEN RD SUITE H-112
SCOTTSDALE AZ
85260-5504
US

IV. Provider business mailing address

10603 N HAYDEN RD SUITE H-112
SCOTTSDALE AZ
85260-5504
US

V. Phone/Fax

Practice location:
  • Phone: 480-922-9933
  • Fax: 480-607-9120
Mailing address:
  • Phone: 480-922-9933
  • Fax: 480-607-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD4868
License Number StateAZ

VIII. Authorized Official

Name: DR. CARL JEFFREY GASSMANN
Title or Position: BUSINESS OWNER
Credential: M.D., D.D.S.
Phone: 480-922-9933