Healthcare Provider Details

I. General information

NPI: 1548304710
Provider Name (Legal Business Name): ORAL SURGERY ASSOCATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OAK TREE LN
DAKOTA DUNES SD
57049-5095
US

IV. Provider business mailing address

301 OAK TREE LN
DAKOTA DUNES SD
57049-5095
US

V. Phone/Fax

Practice location:
  • Phone: 605-242-0107
  • Fax: 605-242-0145
Mailing address:
  • Phone: 605-242-0107
  • Fax: 605-242-0145

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: CLINTON E NORBY
Title or Position: OMFS/PRESIDENT
Credential: DDS
Phone: 605-242-0107