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General NPI Number Information
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NPI Number | 1306615380
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Entity Type | Organization
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Legal Business Name | AREA OMS
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Dates
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Enumeration Date | 01/01/2024
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Last Update Date | 01/01/2024
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Provider Practice Location Address
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Address Line | 301 S ROOSEVELT DR
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City | BEAVER DAM
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State | WI
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Zip | 53916-2439
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Country | US
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Telephone | 920-365-9711
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Fax |
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Provider Business Mailing Address
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Address Line | 301 S ROOSEVELT DR
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City | BEAVER DAM
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State | WI
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Zip | 53916-2439
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Country | US
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Telephone | 920-365-9711
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JARROD THOMAS
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Credential | DDS
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Telephone | 920-261-0495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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