Provider Demographics
NPI:1396343737
Name:FACE AND JAW SURGEONS PC
Entity type:Organization
Organization Name:FACE AND JAW SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEINJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-258-7220
Mailing Address - Street 1:4344 20TH AVE S STE 2
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-7436
Mailing Address - Country:US
Mailing Address - Phone:701-239-5969
Mailing Address - Fax:701-239-0034
Practice Address - Street 1:1517 12 AVE NE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401
Practice Address - Country:US
Practice Address - Phone:701-239-5969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FACE AND JAW SURGEONS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty