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General NPI Number Information
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NPI Number | 1568339711
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Entity Type | Organization
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Legal Business Name | OR OMS SPECIALTY DENTAL SERVICES, LLC
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Dates
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Enumeration Date | 10/22/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 250 CHURCH ST SE STE 102
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City | SALEM
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State | OR
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Zip | 97301-3758
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Country | US
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Telephone | 503-581-1999
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Fax | 503-581-1107
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Provider Business Mailing Address
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Address Line | 1610 54TH AVE N STE 205
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City | NASHVILLE
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State | TN
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Zip | 37209-1442
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Country | US
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Telephone | 615-678-0759
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Fax |
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Authorized Official
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Title or Position | SR. DIRECTOR OF CREDENTIALING
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Name | CHARLOTTE DASCH
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Credential |
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Telephone | 615-678-0759
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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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