Provider Demographics
NPI:1295804300
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:DDS MS
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:PREISLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:701-239-5969
Mailing Address - Street 1:4344 20TH AVE S
Mailing Address - Street 2:STE 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 1:4344 20TH AVE S
Practice Address - Street 2:STE 2
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-7436
Practice Address - Country:US
Practice Address - Phone:701-239-5969
Practice Address - Fax:701-239-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41329Medicaid
ND41329Medicaid