Healthcare Provider Details

I. General information

NPI: 1740066349
Provider Name (Legal Business Name): SCOTTSDALE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6945 E SAHUARO DR STE 101
SCOTTSDALE AZ
85254-6722
US

IV. Provider business mailing address

11029 N 128TH PL
SCOTTSDALE AZ
85259-4467
US

V. Phone/Fax

Practice location:
  • Phone: 503-412-8579
  • Fax:
Mailing address:
  • Phone: 503-412-8579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: JAYSON KIRCHHOFER
Title or Position: OWNER
Credential: DMD, MD
Phone: 503-412-8579