Provider Demographics
NPI:1235440504
Name:ORAL AND MAXILLOFACIAL ASSOCIATES OF ARIZONA
Entity Type:Organization
Organization Name:ORAL AND MAXILLOFACIAL ASSOCIATES OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-659-5977
Mailing Address - Street 1:2855 E BROWN RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-4213
Mailing Address - Country:US
Mailing Address - Phone:480-659-5977
Mailing Address - Fax:
Practice Address - Street 1:2855 E BROWN RD
Practice Address - Street 2:SUITE 15
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-4213
Practice Address - Country:US
Practice Address - Phone:480-659-5977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7957261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery