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General NPI Number Information
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NPI Number | 1407070006
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Entity Type | Organization
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Legal Business Name | FACIAL AND ORAL SURGERY ASSOCIATES
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 5 COMMUNITY DR
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City | AUGUSTA
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State | ME
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Zip | 04330-8087
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Country | US
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Telephone | 207-622-5814
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Fax | 207-621-4360
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Provider Business Mailing Address
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Address Line | 5 COMMUNITY DR
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City | AUGUSTA
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State | ME
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Zip | 04330-8087
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Country | US
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Telephone | 207-622-5814
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Fax | 207-621-4360
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Authorized Official
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Title or Position | VICE PRESIDENT / SECRETARY
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Name | DR. R. RUBERT BERUBE
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Credential |
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Telephone | 207-622-5814
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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 | 3423
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License Number State | ME
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