Provider Demographics
NPI:1770029365
Name:OASIS DENTAL SERVICES, PLLC
Entity Type:Organization
Organization Name:OASIS DENTAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:RODDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-774-4030
Mailing Address - Street 1:930 N SWITZER CANYON DR
Mailing Address - Street 2:#200
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4824
Mailing Address - Country:US
Mailing Address - Phone:928-774-4030
Mailing Address - Fax:928-233-6901
Practice Address - Street 1:930 N SWITZER CANYON DR
Practice Address - Street 2:#200
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4824
Practice Address - Country:US
Practice Address - Phone:928-774-4030
Practice Address - Fax:928-233-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
D009628261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental