Healthcare Provider Details

I. General information

NPI: 1700091238
Provider Name (Legal Business Name): ARIZONA ORAL AND MAXILLOFACIAL SURGEONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 E TANQUE VERDE RD
TUCSON AZ
85715-3477
US

IV. Provider business mailing address

7455 E TANQUE VERDE RD
TUCSON AZ
85715-3477
US

V. Phone/Fax

Practice location:
  • Phone: 520-745-2454
  • Fax:
Mailing address:
  • Phone: 520-745-2454
  • 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: ROBERT S. WOOD
Title or Position: OWNER/SENIOR PARTNER
Credential: DDS
Phone: 520-745-2454