# AZ OMS SPECIALTY DENTAL SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** AZ OMS SPECIALTY DENTAL BRANDS, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1144900994
- **Legal business name:** AZ OMS SPECIALTY DENTAL BRANDS, LLC
- **Authorized official:** CHARLOTTE DASCH (DIRECTOR OF CREDENTIALING & PR)
- **Authorized official phone:** (504) 638-0303

## Contact information

- **Practice address:** 42104 N VENTURE DR STE 106, PHOENIX, AZ 85086-3823
- **Practice address phone:** (623) 551-6556
- **Mailing address:** 1610 54TH AVE N STE 205, NASHVILLE, TN 37209-1442
- **Mailing address phone:** (504) 638-0303

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 07/18/2023
- **Last updated:** 08/02/2023