Healthcare Provider Details

I. General information

NPI: 1427143692
Provider Name (Legal Business Name): JOHN CHRISTOPHER OATIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17250 N 43RD AVE SUITE 3
GLENDALE AZ
85308
US

IV. Provider business mailing address

17250 N 43RD AVE SUITE 3
GLENDALE AZ
85308
US

V. Phone/Fax

Practice location:
  • Phone: 602-978-0901
  • Fax: 602-978-0292
Mailing address:
  • Phone: 602-978-0901
  • Fax: 602-978-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2294
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: