MEDICARE: ARROWHEAD ORAL & MAXILLOFACIAL SURGERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0106X	Oral and Maxillofacial Pathology Dentistry	D5314	AZ

General Provider Information

NPI Number	:	1023166360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARROWHEAD ORAL & MAXILLOFACIAL SURGERY

Provider Business Mailing Address
First Line	:	18555 N 79TH AVE
Second Line	:	#A103
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8370
Country	:	US
Telephone Number	:	623-412-0310
Fax Number	:	623-412-2188

Provider Business Practice Location Address
First Line	:	18555 N 79TH AVE
Second Line	:	#A103
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8370
Country	:	US
Telephone Number	:	623-412-0310
Fax Number	:	623-412-2188

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL G ALLARD
Credential	:	DDS.MD.
Telephone Number	:	623-412-0310

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	09/20/2007

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