Provider Demographics
NPI:1477679157
Name:FACIAL & ORAL SURGERY, LLC.
Entity Type:Organization
Organization Name:FACIAL & ORAL SURGERY, LLC.
Other - Org Name:MSL FACIAL & ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-699-9499
Mailing Address - Street 1:17 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-1605
Mailing Address - Country:US
Mailing Address - Phone:508-699-9499
Mailing Address - Fax:508-699-4217
Practice Address - Street 1:17 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-1605
Practice Address - Country:US
Practice Address - Phone:508-699-9499
Practice Address - Fax:508-699-4217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty