Healthcare Provider Details

I. General information

NPI: 1184625980
Provider Name (Legal Business Name): ASSOCIATES FOR ORAL & MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 E MCANDREWS RD #A
MEDFORD OR
97504-5334
US

IV. Provider business mailing address

1625 E MCANDREWS RD #A
MEDFORD OR
97504-5334
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-3781
  • Fax: 541-779-6523
Mailing address:
  • Phone: 541-779-3781
  • Fax: 541-779-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7614
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7756
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5748
License Number StateOR

VIII. Authorized Official

Name: MR. JAMES D SAVAGE
Title or Position: DOCTOR
Credential: DDS
Phone: 541-779-3781