Provider Demographics
NPI:1215446042
Name:FRONTIER ORAL & MAXILLOFACIAL SURGERY LLC
Entity type:Organization
Organization Name:FRONTIER ORAL & MAXILLOFACIAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAMI JO
Authorized Official - Middle Name:
Authorized Official - Last Name:GANUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-865-5254
Mailing Address - Street 1:3220 PROVIDENCE DRIVE STE E3080
Mailing Address - Street 2:3220 PROVIDENCE DRIVE STE E3080
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4657
Mailing Address - Country:US
Mailing Address - Phone:907-375-8785
Mailing Address - Fax:907-375-8788
Practice Address - Street 1:3220 PROVIDENCE DR STE E3-080
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4657
Practice Address - Country:US
Practice Address - Phone:907-375-8785
Practice Address - Fax:907-375-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty