Healthcare Provider Details

I. General information

NPI: 1285582262
Provider Name (Legal Business Name): ADVANCED ORAL SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 WESTOWN PKWY STE 100
WEST DES MOINES IA
50266-1096
US

IV. Provider business mailing address

4320 WESTOWN PKWY STE 100
WEST DES MOINES IA
50266-1096
US

V. Phone/Fax

Practice location:
  • Phone: 515-417-1500
  • Fax: 515-417-2811
Mailing address:
  • Phone: 515-417-1500
  • Fax: 515-417-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JENN HERITAGE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 402-805-4516