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General NPI Number Information
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NPI Number | 1740533892
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Entity Type | Organization
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Legal Business Name | FACIAL SURGERY INSTITUTE, PLC
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 09/08/2020
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Provider Practice Location Address
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Address Line | 1029 LINCOLN AVE SUITE #4
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City | MARQUETTE
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State | MI
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Zip | 49855-2679
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Country | US
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Telephone | 906-225-5959
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Fax |
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Provider Business Mailing Address
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Address Line | 1029 LINCOLN AVE SUITE #4
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City | MARQUETTE
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State | MI
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Zip | 49855-2679
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Country | US
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Telephone | 906-225-5959
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | FRANK FARBOD
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Credential | MD,DMD,FACS,FRCS
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Telephone | 906-225-5959
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2082S0099X
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Taxonomy Name | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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