Provider Demographics
NPI:1477063881
Name:SONOMA ORAL & FACIAL SURGERY, PLLC
Entity Type:Organization
Organization Name:SONOMA ORAL & FACIAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPANGANBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-279-3113
Mailing Address - Street 1:7400 S POWER RD STE 136
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-9284
Mailing Address - Country:US
Mailing Address - Phone:480-279-3113
Mailing Address - Fax:480-279-2741
Practice Address - Street 1:7400 S POWER RD STE 136
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-9284
Practice Address - Country:US
Practice Address - Phone:480-279-3113
Practice Address - Fax:480-279-2741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7166261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery