Provider Demographics
NPI:1184625980
Name:ASSOCIATES FOR ORAL & MAXILLOFACIAL SURGERY
Entity type:Organization
Organization Name:ASSOCIATES FOR ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-779-3781
Mailing Address - Street 1:1625 E MCANDREWS RD
Mailing Address - Street 2:#A
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5334
Mailing Address - Country:US
Mailing Address - Phone:541-779-3781
Mailing Address - Fax:541-779-6523
Practice Address - Street 1:1625 E MCANDREWS RD
Practice Address - Street 2:#A
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5334
Practice Address - Country:US
Practice Address - Phone:541-779-3781
Practice Address - Fax:541-779-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR76141223S0112X
OR77561223S0112X
OR57481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty