Provider Demographics
NPI:1639383672
Name:SACRAMENTO ORAL SURGERY
Entity Type:Organization
Organization Name:SACRAMENTO ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROYSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-448-4500
Mailing Address - Street 1:2503 K ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5101
Mailing Address - Country:US
Mailing Address - Phone:916-448-4500
Mailing Address - Fax:
Practice Address - Street 1:2503 K STREET
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816
Practice Address - Country:US
Practice Address - Phone:916-448-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty