Oasis Oral and Facial Surgery PLLC

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

Legal business name

OASIS ORAL AND FACIAL SURGERY PLLC

Practice address

21300 N John Wayne Pkwy Ste 114
Maricopa, AZ 85139-8964

Phone

(520) 231-6700

Fax

(520) 208-9066

NPI assigned

Sep 25, 2018

Last updated

Dec 28, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jared Kenney, DDSNPI 1104238716

Title

Owner

Phone

(520) 231-6700

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jared Kenney, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Maricopa, AZ
  • NPI 1104238716
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735344000000",
    "number": "1023593068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21300 N. JOHN WAYNE PKWY STE.#114",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851397834",
            "telephone_number": "520-231-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21300 N JOHN WAYNE PKWY STE 114",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851398964",
            "telephone_number": "520-231-6700",
            "fax_number": "520-208-9066"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 S Gilbert Rd Ste 117",
            "address_purpose": "LOCATION",
            "city": "Chandler",
            "state": "AZ",
            "postal_code": "852865107",
            "country_code": "US",
            "telephone_number": "520-231-6700",
            "fax_number": "520-208-9066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OASIS ORAL AND FACIAL SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-25",
        "last_updated": "2024-12-28",
        "certification_date": "2024-12-28",
        "status": "A",
        "authorized_official_last_name": "KENNEY",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "520-231-6700",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral & Maxillofacial Surgery (D.M.D.) in Maricopa, AZ
• Providers in Maricopa, AZ by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.