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General NPI Number Information
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NPI Number | 1316492960
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Entity Type | Organization
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Legal Business Name | NORTH STAR ORAL & FACIAL SURGERY, LLC
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 2009 COWLES ST
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City | FAIRBANKS
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State | AK
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Zip | 99701-5916
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Country | US
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Telephone | 907-374-8111
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Fax | 907-374-8119
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Provider Business Mailing Address
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Address Line | 119 N CUSHMAN ST STE 400
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City | FAIRBANKS
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State | AK
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Zip | 99701-2879
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Country | US
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Telephone | 907-374-8111
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Fax | 907-374-8119
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. RICHARD WILLIAM HOMPESCH III
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Credential | DDS
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Telephone | 907-374-8111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 105542
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License Number State | AK
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