Provider Demographics
NPI:1427082437
Name:FACIAL & ORAL SURGERY, LLC
Entity type:Organization
Organization Name:FACIAL & ORAL SURGERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:CASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-336-7848
Mailing Address - Street 1:1295 FALL RIVER AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-5931
Mailing Address - Country:US
Mailing Address - Phone:508-336-7848
Mailing Address - Fax:508-336-6580
Practice Address - Street 1:1295 FALL RIVER AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-5931
Practice Address - Country:US
Practice Address - Phone:508-336-7848
Practice Address - Fax:508-336-6580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty