1922982404 NPI number — PRECISION ORAL AND MAXILLOFACIAL SURGERY

Table of content: KORTNEY CARLIN MS, LADC (NPI 1255146791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922982404 NPI number — PRECISION ORAL AND MAXILLOFACIAL SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRECISION ORAL AND MAXILLOFACIAL SURGERY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922982404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2410 W HORSETAIL TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85085-7007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-482-1398
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2060 W WHISPERING WIND DR STE 167
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85085-2869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-518-2325
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2025

Additional Information

Authorized Official

Authorized Official Last Name:
ALI
Authorized Official First Name:
AKBER
Authorized Official Middle Name:
MIR
Authorized Official Title or Position:
ORAL SURGEON
Authorized Official Telephone Number:
626-482-1398

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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