Provider Demographics
NPI:1952162372
Name:MJX MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:MJX MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:707-733-3798
Mailing Address - Street 1:1350 NW 8TH CT APT 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2329
Mailing Address - Country:US
Mailing Address - Phone:707-733-3798
Mailing Address - Fax:
Practice Address - Street 1:1350 NW 8TH CT APT 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2329
Practice Address - Country:US
Practice Address - Phone:707-733-3798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty