Provider Demographics
NPI:1023593068
Name:OASIS ORAL AND FACIAL SURGERY PLLC
Entity type:Organization
Organization Name:OASIS ORAL AND FACIAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-231-6700
Mailing Address - Street 1:21300 N. JOHN WAYNE PKWY STE.#114
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-7834
Mailing Address - Country:US
Mailing Address - Phone:520-231-6700
Mailing Address - Fax:
Practice Address - Street 1:21300 N JOHN WAYNE PKWY STE 114
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8964
Practice Address - Country:US
Practice Address - Phone:520-231-6700
Practice Address - Fax:520-208-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty