| Southwest Orofacial Group, Inc. | |
|
10214 N Tatum Blvd Ste A1100 Phoenix AZ 85028-4243 | |
| (602) 992-1486 | |
| (602) 992-6604 |
| Full Name | Southwest Orofacial Group, Inc. |
|---|---|
| Speciality | Durable Medical Equipment & Medical Supplies |
| Location | 10214 N Tatum Blvd Ste A1100, Phoenix, Arizona |
| Authorized Official Name and Position | Therese Garvey (OWNER) |
| Authorized Official Contact | 2168707911 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Orofacial Group, Inc. 10214 N Tatum Blvd Ste A1100 Phoenix AZ 85028-4243 Ph: (602) 992-1486 | Southwest Orofacial Group, Inc. 10214 N Tatum Blvd Ste A1100 Phoenix AZ 85028-4243 Ph: (602) 992-1486 |
| NPI Number | 1487733572 |
|---|---|
| Provider Enumeration Date | 11/02/2006 |
| Last Update Date | 08/01/2024 |
| Medicare PECOS PAC ID | 4981786308 |
|---|---|
| Medicare Enrollment ID | O20080124000255 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487733572 | NPI | - | NPPES |
| Provider Name | Seena Patel |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1790040749 PECOS PAC ID: 9638320179 Enrollment ID: I20121110000161 |
| Provider Name | Dharti N Patel |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1497867535 PECOS PAC ID: 5597053918 Enrollment ID: I20161018000122 |
| Provider Name | Basilios C Costaras |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1053644880 PECOS PAC ID: 9032246434 Enrollment ID: I20190718001284 |
| Provider Name | Jeffrey C Wight |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1043541907 PECOS PAC ID: 1052734431 Enrollment ID: I20200701001759 |
| Provider Name | Veena R Kanti |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1841825171 PECOS PAC ID: 7214315431 Enrollment ID: I20220531001980 |
| Provider Name | Georgia M Peterson-houle |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1578642559 PECOS PAC ID: 9830507466 Enrollment ID: I20240423002717 |
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