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General NPI Number Information
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NPI Number | 1568667061
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Entity Type | Organization
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Legal Business Name | ORAL & FACIAL SURGEONS OF ARIZONA
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 12/28/2017
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Provider Practice Location Address
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Address Line | 5050 N. 40TH STREET SUITE 180
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City | PHOENIX
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State | AZ
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Zip | 85018
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Country | US
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Telephone | 602-957-0332
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Fax | 602-957-3282
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Provider Business Mailing Address
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Address Line | 5050 N. 40TH STREET SUITE 180
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City | PHOENIX
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State | AZ
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Zip | 85018
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Country | US
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Telephone | 602-957-0332
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Fax | 602-957-3282
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Authorized Official
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Title or Position | OWNER
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Name | DR. JON GREGORY SABOL
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Credential | D.M.D., M.D.
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Telephone | 602-957-0332
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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 | 6816
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 6147
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License Number State | AZ
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Taxonomy #3
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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 | AZ
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