=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992997290
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCOTTSDALE SURGICAL ARTS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2007
-----------------------------------------------------
Last Update Date | 08/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10603 N HAYDEN RD SUITE H-112
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-922-9933
-----------------------------------------------------
Fax | 480-607-9120
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10603 N HAYDEN RD SUITE H-112
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-922-9933
-----------------------------------------------------
Fax | 480-607-9120
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS OWNER
-----------------------------------------------------
Name | DR. CARL JEFFREY GASSMANN
-----------------------------------------------------
Credential | M.D., D.D.S.
-----------------------------------------------------
Telephone | 480-922-9933
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | D4868
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------