Provider Demographics
NPI:1306034285
Name:ORAL SURGERY OFFICE, INC.
Entity Type:Organization
Organization Name:ORAL SURGERY OFFICE, INC.
Other - Org Name:DR. REGINAL GOWANS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:SETTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-487-5152
Mailing Address - Street 1:730 SUNRISE AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4567
Mailing Address - Country:US
Mailing Address - Phone:916-782-2161
Mailing Address - Fax:916-782-0677
Practice Address - Street 1:730 SUNRISE AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4567
Practice Address - Country:US
Practice Address - Phone:916-782-2161
Practice Address - Fax:916-782-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA918301223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty