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General NPI Number Information
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NPI Number | 1023166360
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Entity Type | Organization
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Legal Business Name | ARROWHEAD ORAL & MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 18555 N 79TH AVE #A103
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City | GLENDALE
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State | AZ
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Zip | 85308-8370
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Country | US
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Telephone | 623-412-0310
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Fax | 623-412-2188
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Provider Business Mailing Address
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Address Line | 18555 N 79TH AVE #A103
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City | GLENDALE
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State | AZ
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Zip | 85308-8370
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Country | US
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Telephone | 623-412-0310
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Fax | 623-412-2188
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL G ALLARD
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Credential | DDS.MD.
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Telephone | 623-412-0310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | D5314
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License Number State | AZ
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