NPIMap

Organization Active NPI

Az Oms Specialty Dental Services, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Phoenix, AZ
National Provider Identifier
1144900994
Registry record updated Aug 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
AZ OMS SPECIALTY DENTAL SERVICES, LLC
Practice address
42104 N Venture Dr Ste 106
Phoenix, AZ 85086-3823
Phone
(623) 551-6556
NPI assigned
Jul 18, 2023
Organization subpart
Yes
Parent organization
AZ OMS SPECIALTY DENTAL BRANDS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 2, 2023

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

Authorized official

Name
Charlotte Dasch
Title
Director of Credentialing & PR
Phone
(504) 638-0303

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

42104 N Venture Dr Ste 106
Phoenix, AZ 85086-3823

Mailing address

1610 54TH Ave N Ste 205
Nashville, TN 37209-1442
Phone (504) 638-0303

National Provider Directory

National Provider Directory
Tax ID family
Az Oms Specialty Dental Services LLC4 organizations share this tax ID, including this one
Part of
Az Oms Specialty Dental Services LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1876 E Innovation Park Dr
Oro Valley, AZ 85755
Phone (520) 745-2454

42104 N Venture Dr
Ste 106
Phoenix, AZ 85086
Phone (623) 551-6556

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1689638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690934400000",
    "number": "1144900994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 54TH AVE N STE 205",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372091442",
            "telephone_number": "504-638-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42104 N VENTURE DR STE 106",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850863823",
            "telephone_number": "623-551-6556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZ OMS SPECIALTY DENTAL SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AZ OMS SPECIALTY DENTAL BRANDS, LLC",
        "enumeration_date": "2023-07-18",
        "last_updated": "2023-08-02",
        "certification_date": "2023-08-02",
        "status": "A",
        "authorized_official_last_name": "DASCH",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING & PR",
        "authorized_official_telephone_number": "504-638-0303"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.