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General NPI Number Information
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NPI Number | 1457776981
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Entity Type | Organization
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Legal Business Name | ARIZONA OCULAR AND FACIAL PLASTIC SURGERY, PLLC
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 3501 N. SCOTTSDALE ROAD SUITE 326
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-5650
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Country | US
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Telephone | 480-949-5990
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Fax | 480-949-0509
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Provider Business Mailing Address
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Address Line | 3501 N. SCOTTSDALE ROAD SUITE 326
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-5650
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Country | US
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Telephone | 480-949-5990
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Fax | 480-949-0509
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DUSTIN MICHAEL HERINGER
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Credential | M.D.
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Telephone | 480-949-5990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 36057
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License Number State | AZ
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