Provider Demographics
NPI:1457495491
Name:ASSOCIATED ORAL AND MAXILLOFACIAL SURGEONS, PA
Entity Type:Organization
Organization Name:ASSOCIATED ORAL AND MAXILLOFACIAL SURGEONS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:STANNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-574-1639
Mailing Address - Street 1:7136 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3100
Mailing Address - Country:US
Mailing Address - Phone:763-574-1639
Mailing Address - Fax:
Practice Address - Street 1:7136 UNIVERSITY AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3100
Practice Address - Country:US
Practice Address - Phone:763-574-1639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty