Organization Name:  ORAL & FACIAL SURGERY CENTER PA


Practice Location:
3996 N FRONTAGE RD  FAYETTEVILLE, AR 72703 US
Tel: 479-582-3002  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	1223S0112X	Dental Providers Dentist Oral and Maxillofacial Surgery
Y	204E00000X	Physicians Oral & Maxillofacial Surgery

Other Provider Identifiers:

Issuer	Number	State	Type
	127319680	AR	05
	230273680	AR	05
	239128680	AR	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin