Provider Demographics
NPI:1063710994
Name:FAIRBANKS ORAL SURGERY, LLC
Entity type:Organization
Organization Name:FAIRBANKS ORAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:SATOW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-388-1386
Mailing Address - Street 1:114 MINNIE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3006
Mailing Address - Country:US
Mailing Address - Phone:907-455-1040
Mailing Address - Fax:907-455-2010
Practice Address - Street 1:12810 GLEN ALPS RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-6956
Practice Address - Country:US
Practice Address - Phone:907-388-1386
Practice Address - Fax:907-455-2010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE ORAL & MAXILLOFACIAL SURGERY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1641223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty