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General NPI Number Information
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NPI Number | 1689638538
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Entity Type | Organization
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Legal Business Name | ADVANCE ORAL AND MAXILLOFACIAL SURGERY A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/16/2006
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Last Update Date | 06/14/2019
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Provider Practice Location Address
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Address Line | 1570 S RAINBOW BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89146-2956
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Country | US
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Telephone | 702-258-0085
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Fax |
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Provider Business Mailing Address
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Address Line | 1570 S RAINBOW BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89146-2956
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Country | US
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Telephone | 702-258-0085
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN A. SAXE
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Credential | DMD
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Telephone | 702-258-0085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | S220
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License Number State | NV
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