Provider Demographics
NPI:1417755505
Name:SAN TAN ORAL SURGERY
Entity type:Organization
Organization Name:SAN TAN ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KESTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-659-9820
Mailing Address - Street 1:3303 S LINDSAY RD STE 112
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-1504
Mailing Address - Country:US
Mailing Address - Phone:480-659-9820
Mailing Address - Fax:
Practice Address - Street 1:3303 S LINDSAY RD STE 112
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-1504
Practice Address - Country:US
Practice Address - Phone:480-659-9820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental