Provider Demographics
NPI:1558701953
Name:OCEAN ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:OCEAN ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-682-0933
Mailing Address - Street 1:1111 E OCEAN AVE
Mailing Address - Street 2:#9
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7076
Mailing Address - Country:US
Mailing Address - Phone:805-735-3665
Mailing Address - Fax:
Practice Address - Street 1:1111 E OCEAN AVE
Practice Address - Street 2:#9
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7076
Practice Address - Country:US
Practice Address - Phone:805-735-3665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty