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General NPI Number Information
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NPI Number | 1760741730
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Entity Type | Organization
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Legal Business Name | OASIS DENTAL, LLC
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 1 BELMONT AVENUE SUITE 516
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City | BALA CYNWYD
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State | PA
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Zip | 19004
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Country | US
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Telephone | 484-278-4134
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Fax | 484-278-4133
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Provider Business Mailing Address
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Address Line | 1 BELMONT AVENUE SUITE 516
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City | BALA CYNWYD
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State | PA
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Zip | 19004
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Country | US
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Telephone | 484-278-4134
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Fax | 484-278-4133
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | RUTH JOHNSON
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Credential |
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Telephone | 484-278-4134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DS024203L
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License Number State | PA
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