Provider Demographics
NPI:1548611643
Name:OCEAN ORAL AND MAXILLOFACIAL SURGERY, INC.
Entity Type:Organization
Organization Name:OCEAN ORAL AND MAXILLOFACIAL SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:KIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-735-3665
Mailing Address - Street 1:1111 E OCEAN AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-2501
Mailing Address - Country:US
Mailing Address - Phone:805-735-3665
Mailing Address - Fax:805-735-5665
Practice Address - Street 1:1111 E OCEAN AVE STE 9
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-2501
Practice Address - Country:US
Practice Address - Phone:805-735-3665
Practice Address - Fax:805-735-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29327174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty