Provider Demographics
NPI:1316492960
Name:NORTH STAR ORAL & FACIAL SURGERY, LLC
Entity type:Organization
Organization Name:NORTH STAR ORAL & FACIAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOMPESCH
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-374-8111
Mailing Address - Street 1:119 N CUSHMAN ST
Mailing Address - Street 2:STE 400
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-2879
Mailing Address - Country:US
Mailing Address - Phone:907-374-8111
Mailing Address - Fax:907-374-8119
Practice Address - Street 1:2009 COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5916
Practice Address - Country:US
Practice Address - Phone:907-374-8111
Practice Address - Fax:907-374-8119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK105542261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery