Provider Demographics
NPI:1538821681
Name:HIGH DESERT ORAL SURGERY
Entity type:Organization
Organization Name:HIGH DESERT ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTLIANG MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUINEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-750-6897
Mailing Address - Street 1:30012 N CAVE CREEK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5833
Mailing Address - Country:US
Mailing Address - Phone:480-575-0844
Mailing Address - Fax:
Practice Address - Street 1:30012 N CAVE CREEK RD STE 103
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-5833
Practice Address - Country:US
Practice Address - Phone:480-575-0844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty