Provider Demographics
NPI:1942703657
Name:ADVANCED IMPLANT AND ORAL SURGERY
Entity Type:Organization
Organization Name:ADVANCED IMPLANT AND ORAL SURGERY
Other - Org Name:SONOMA ORAL AND FACIAL SURGERY OF YUMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPANGANBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-279-3113
Mailing Address - Street 1:1325 W 16TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4496
Mailing Address - Country:US
Mailing Address - Phone:928-329-6447
Mailing Address - Fax:928-782-8036
Practice Address - Street 1:1325 W 16TH ST STE 3
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4496
Practice Address - Country:US
Practice Address - Phone:928-329-6447
Practice Address - Fax:928-782-8036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial SurgeryGroup - Single Specialty