Healthcare Provider Details

I. General information

NPI: 1356275697
Provider Name (Legal Business Name): OSCAR JAIME RODRIGUEZ MIRAMONTES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23350 N 163RD AVE # 100
SURPRISE AZ
85387-0044
US

IV. Provider business mailing address

24971 N 83RD AVE
PEORIA AZ
85383-4383
US

V. Phone/Fax

Practice location:
  • Phone: 602-922-7380
  • Fax:
Mailing address:
  • Phone: 623-323-9709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD012853
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: