Provider Demographics
NPI:1821209909
Name:FACIAL & AESTHETIC PLASTIC SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:FACIAL & AESTHETIC PLASTIC SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:GENTILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-758-0191
Mailing Address - Street 1:6505 MARKET ST
Mailing Address - Street 2:SUITE A103B
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3457
Mailing Address - Country:US
Mailing Address - Phone:330-758-0191
Mailing Address - Fax:330-726-3577
Practice Address - Street 1:6505 MARKET ST
Practice Address - Street 2:SUITE A103B
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3457
Practice Address - Country:US
Practice Address - Phone:330-758-0191
Practice Address - Fax:330-726-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center