Provider Demographics
NPI:1992997290
Name:SCOTTSDALE SURGICAL ARTS, P.C.
Entity type:Organization
Organization Name:SCOTTSDALE SURGICAL ARTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:GASSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:480-922-9933
Mailing Address - Street 1:10603 N HAYDEN RD
Mailing Address - Street 2:SUITE H-112
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5504
Mailing Address - Country:US
Mailing Address - Phone:480-922-9933
Mailing Address - Fax:480-607-9120
Practice Address - Street 1:10603 N HAYDEN RD
Practice Address - Street 2:SUITE H-112
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5504
Practice Address - Country:US
Practice Address - Phone:480-922-9933
Practice Address - Fax:480-607-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD48681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0801420OtherBCBS
AZ898101OtherUNITED CONCORDIA
AZ2004003OtherAETNA