# ORAL & MAXILLOFACIAL SURGERY SPECIALISTS, PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** OMS Specialists
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902917057
- **Authorized official:** KIRBY CHARLES JOHNSON DDS (PRESIDENT)
- **Authorized official phone:** (612) 788-9246

## Contact information

- **Practice address:** 13784 83RD WAY N STE 92, MAPLE GROVE, MN 55369-7191
- **Practice address phone:** (763) 494-8825
- **Practice address fax:** (763) 494-3269
- **Mailing address:** 550 COUNTY ROAD D, SUITE 12, NEW BRIGHTON, MN 55112
- **Mailing address phone:** (651) 259-9902
- **Mailing address fax:** (651) 259-9930

## 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:** 08/31/2006
- **Last updated:** 07/29/2014