Provider Demographics
NPI:1861032005
Name:SCOTTSDALE FACIAL & ORAL SURGERY LLC
Entity Type:Organization
Organization Name:SCOTTSDALE FACIAL & ORAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-941-5005
Mailing Address - Street 1:3501 N SCOTTSDALE RD STE 226
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5630
Mailing Address - Country:US
Mailing Address - Phone:480-941-5005
Mailing Address - Fax:480-946-0268
Practice Address - Street 1:3501 N SCOTTSDALE RD STE 226
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5630
Practice Address - Country:US
Practice Address - Phone:480-941-5005
Practice Address - Fax:480-946-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty