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General NPI Number Information
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NPI Number | 1275925265
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Entity Type | Organization
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Legal Business Name | ORAL AND FACIAL SURGERY CENTER OF PRESCOTT
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Dates
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Enumeration Date | 02/27/2015
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 5415 DISTICTION WAY
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City | PRESCOTT
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State | AZ
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Zip | 86301
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Country | US
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Telephone | 205-470-0047
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Fax |
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Provider Business Mailing Address
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Address Line | 5415 DISTICTION WAY
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City | PRESCOTT
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State | AZ
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Zip | 86301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | BENJAMIN ABT
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Credential | DMD
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Telephone | 205-470-0047
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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 | 8911
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License Number State | AZ
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