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General NPI Number Information
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NPI Number | 1649717075
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Entity Type | Organization
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Legal Business Name | SCV ORAL AND MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 26357 MCBEAN PKWY STE 255
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City | VALENCIA
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State | CA
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Zip | 91355-5504
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Country | US
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Telephone | 661-255-1515
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Fax | 661-255-1661
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Provider Business Mailing Address
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Address Line | 26357 MCBEAN PKWY STE 255
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City | VALENCIA
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State | CA
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Zip | 91355-5504
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Country | US
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Telephone | 661-255-1515
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Fax | 661-255-1661
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | ROBERT WAYNE MOWER
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Credential | DDS
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Telephone | 661-255-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 45296
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License Number State | CA
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