MEDICARE: SUN CITY ORAL SURGERY AND IMPLANT CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1255121018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN CITY ORAL SURGERY AND IMPLANT CENTER LLC

Provider Business Mailing Address
First Line	:	8815 DYER ST # 215
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79904-2000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8815 DYER ST # 215
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79904-2000
Country	:	US
Telephone Number	:	915-200-2943
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. JAKE WILLIAMS
Credential	:	DDS
Telephone Number	:	385-335-0928

Provider Enumeration Date	:	05/07/2025
Last Update Date	:	05/07/2025

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