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General NPI Number Information
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NPI Number | 1457844516
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Entity Type | Organization
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Legal Business Name | CHANDLER ORAL AND MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 06/12/2018
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Provider Practice Location Address
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Address Line | 1799 E QUEEN CREEK RD STE 4
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City | CHANDLER
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State | AZ
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Zip | 85286-2015
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Country | US
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Telephone | 480-471-6492
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Fax | 480-930-4328
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Provider Business Mailing Address
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Address Line | 1799 E QUEEN CREEK RD STE 4
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City | CHANDLER
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State | AZ
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Zip | 85286-2015
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Country | US
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Telephone | 480-471-6492
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Fax | 480-930-4328
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT YONG
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Credential | DDS
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Telephone | 480-471-6492
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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 | D9701
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License Number State | AZ
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