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General NPI Number Information
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NPI Number | 1366676553
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Entity Type | Organization
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Legal Business Name | AFFILIATED ORAL AND MAXILLOFACIAL SURGEONS P.A.
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Dates
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Enumeration Date | 05/04/2009
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Last Update Date | 05/04/2009
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Provider Practice Location Address
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Address Line | 348 2ND ST SUITE 150
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City | EXCELSIOR
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State | MN
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Zip | 55331-1830
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Country | US
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Telephone | 952-474-6336
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Fax | 952-474-2468
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Provider Business Mailing Address
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Address Line | 348 2ND ST SUITE 150
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City | EXCELSIOR
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State | MN
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Zip | 55331-1830
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Country | US
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Telephone | 952-474-6336
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Fax | 952-474-2468
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | DR. DOUGLAS A CARTER
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Credential | D.D.S.
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Telephone | 952-474-6336
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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 |
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