Provider Demographics
NPI:1871013524
Name:ANTHEM ORAL SURGERY & IMPLANT CENTER
Entity Type:Organization
Organization Name:ANTHEM ORAL SURGERY & IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:BROWN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:480-575-0844
Mailing Address - Street 1:30012 N CAVE CREEK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5833
Mailing Address - Country:US
Mailing Address - Phone:480-575-0844
Mailing Address - Fax:480-575-0845
Practice Address - Street 1:42104 N VENTURE DR
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3823
Practice Address - Country:US
Practice Address - Phone:480-575-0844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANTHEM ORAL SURGERY & IMPLANT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-23
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD57791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty