Organization
JAXOMS, P.A.
Active
Organization
JAXOMS, P.A.
Active
Parent organization
JAXOMS, P.A.
Other names
Gulf Coast Dental Implants & Oral Surgery
Organization subpart
Yes
Provider details
NPI number
Legal business name
JAXOMS, P.A.
Authorized official
JENN HERITAGE (CREDENTIALING MANAGER)
(402) 805-4516
Entity
Organization
Contact information
Practice address
17425 BRIDGE HILL CT STE 103, TAMPA, FL 33647-3657
(402) 805-4516
Mailing address
17425 BRIDGE HILL CT STE 103, TAMPA, FL 33647-3657
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
06/26/2026
Last updated
06/26/2026
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