Provider Demographics
NPI:1619423787
Name:K & L OMS LLC
Entity Type:Organization
Organization Name:K & L OMS LLC
Other - Org Name:K & L OMS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRITY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-617-3993
Mailing Address - Street 1:1475 NE WILLIAMSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-382-1053
Mailing Address - Fax:
Practice Address - Street 1:1475 NE WILLIAMSON BLVD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701
Practice Address - Country:US
Practice Address - Phone:541-382-1053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K & L OMS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-29
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD66291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty