Provider Demographics
NPI:1649439761
Name:OASIS DENTAL SERVICES
Entity type:Organization
Organization Name:OASIS DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRELLA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:256-864-9571
Mailing Address - Street 1:12205 COUNTY LINE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7719
Mailing Address - Country:US
Mailing Address - Phone:256-864-9571
Mailing Address - Fax:256-864-9575
Practice Address - Street 1:12205 COUNTY LINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-7719
Practice Address - Country:US
Practice Address - Phone:256-864-9571
Practice Address - Fax:256-864-9575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4640261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental