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General NPI Number Information
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NPI Number | 1275859159
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN ORAL AND MAXILLOFACIAL SURGERY, P.A.
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Dates
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Enumeration Date | 04/16/2010
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Last Update Date | 04/16/2010
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Provider Practice Location Address
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Address Line | 2717 SUPERIOR DR NW SUITE B
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City | ROCHESTER
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State | MN
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Zip | 55901-3035
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Country | US
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Telephone | 507-281-5820
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Fax | 507-282-6543
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Provider Business Mailing Address
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Address Line | 2717 SUPERIOR DR NW SUITE B
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City | ROCHESTER
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State | MN
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Zip | 55901-3035
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Country | US
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Telephone | 507-281-5820
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Fax | 507-282-6543
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. MARGY VICKERS
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Credential |
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Telephone | 504-281-5820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State | MN
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