# JAXOMS, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** JAXOMS, P.A.
- **Other names:** Gulf Coast Dental Implants & Oral Surgery
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1619893336
- **Legal business name:** JAXOMS, P.A.
- **Authorized official:** JENN HERITAGE (CREDENTIALING MANAGER)
- **Authorized official phone:** (402) 805-4516

## Contact information

- **Practice address:** 17425 BRIDGE HILL CT STE 103, TAMPA, FL 33647-3657
- **Practice address phone:** (656) 255-4085
- **Practice address fax:** (656) 255-4340
- **Mailing address:** 17425 BRIDGE HILL CT STE 103, TAMPA, FL 33647-3657

## 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:** 06/26/2026
- **Last updated:** 10/09/2026