Provider Demographics
NPI:1467877969
Name:ARKANSAS MAXILLOFACIAL SURGERY CENTER
Entity Type:Organization
Organization Name:ARKANSAS MAXILLOFACIAL SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHOEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-225-8929
Mailing Address - Street 1:411 OFFICE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022
Mailing Address - Country:US
Mailing Address - Phone:501-943-3310
Mailing Address - Fax:501-943-0891
Practice Address - Street 1:411 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022
Practice Address - Country:US
Practice Address - Phone:501-943-3310
Practice Address - Fax:501-943-0891
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARKANSAS MAXILLOFACIAL SURGERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1104935782OtherNPI
AR1417989112OtherNPI