Basic Information
| Provider Information | |||||||||
| NPI: | 1457565848 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREATER CHARLOTTE ORAL AND FACIAL SURGERY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10035 PARK CEDAR DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282108911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045429600 | ||||||||
| FaxNumber: | 7045429651 | ||||||||
| Practice Location | |||||||||
| Address1: | 10035 PARK CEDAR DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282108911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045429600 | ||||||||
| FaxNumber: | 7045429651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 10/13/2014 | ||||||||
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| AuthorizedOfficialLastName: | MARASHI | ||||||||
| AuthorizedOfficialFirstName: | AMIR | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7045429600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 01124 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.