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General NPI Number Information
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NPI Number | 1023593068
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Entity Type | Organization
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Legal Business Name | OASIS ORAL AND FACIAL SURGERY PLLC
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Dates
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Enumeration Date | 09/25/2018
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Last Update Date | 12/28/2024
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Provider Practice Location Address
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Address Line | 21300 N JOHN WAYNE PKWY STE 114
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City | MARICOPA
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State | AZ
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Zip | 85139-8964
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Country | US
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Telephone | 520-231-6700
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Fax | 520-208-9066
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Provider Business Mailing Address
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Address Line | 21300 N. JOHN WAYNE PKWY STE.#114
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City | MARICOPA
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State | AZ
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Zip | 85139-7834
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Country | US
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Telephone | 520-231-6700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JARED KENNEY
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Credential | DDS
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Telephone | 520-231-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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