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General NPI Number Information
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NPI Number | 1548304710
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Entity Type | Organization
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Legal Business Name | ORAL SURGERY ASSOCATES, P.C.
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 11/15/2019
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Provider Practice Location Address
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Address Line | 301 OAK TREE LN
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5095
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Country | US
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Telephone | 605-242-0107
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Fax | 605-242-0145
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Provider Business Mailing Address
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Address Line | 301 OAK TREE LN
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City | DAKOTA DUNES
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State | SD
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Zip | 57049-5095
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Country | US
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Telephone | 605-242-0107
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Fax | 605-242-0145
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Authorized Official
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Title or Position | OMFS/PRESIDENT
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Name | CLINTON E NORBY
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Credential | DDS
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Telephone | 605-242-0107
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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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