Provider Demographics
NPI:1457776981
Name:ARIZONA OCULAR AND FACIAL PLASTIC SURGERY, PLLC
Entity type:Organization
Organization Name:ARIZONA OCULAR AND FACIAL PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HERINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-949-5990
Mailing Address - Street 1:3501 N. SCOTTSDALE ROAD
Mailing Address - Street 2:SUITE 326
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5650
Mailing Address - Country:US
Mailing Address - Phone:480-949-5990
Mailing Address - Fax:480-949-0509
Practice Address - Street 1:3501 N. SCOTTSDALE ROAD
Practice Address - Street 2:SUITE 326
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5650
Practice Address - Country:US
Practice Address - Phone:480-949-5990
Practice Address - Fax:480-949-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36057207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty