Provider Demographics
NPI:1740066349
Name:SCOTTSDALE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES PLLC
Entity type:Organization
Organization Name:SCOTTSDALE ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRCHHOFER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:503-412-8579
Mailing Address - Street 1:6885 E COCHISE RD APT 109
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1430
Mailing Address - Country:US
Mailing Address - Phone:503-412-8579
Mailing Address - Fax:
Practice Address - Street 1:6945 E SAHUARO DR STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6722
Practice Address - Country:US
Practice Address - Phone:503-412-8579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery