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OMS SPECIALISTS
NPI 1467563510
Dentist - Oral and Maxillofacial Surgery in Blaine, MN

Active since August 31, 2006CLIA 24D1010021 · Waiver
11800 ABERDEEN ST NE STE 130, BLAINE, MN 55449(763) 757-2220(763) 757-9204 Get Directions Write a Review

NPPES record last updated: July 29, 2014. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Oms Specialists NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

OMS SPECIALISTS (NPI 1467563510) is a healthcare organization registered as an oral and maxillofacial surgery in Blaine, Minnesota and active in the NPI registry since August 2006. The organization holds a CLIA Waiver certificate valid through March 3, 2027 and lists Kirby Charles Johnson, President, as its authorized official.

NPPES Registry Identity

NPI1467563510
Entity TypeOrganization
Primary Taxonomy1223S0112X
Legal Business NameORAL & MAXILLOFACIAL SURGERY SPECIALISTS, PA
Location Address11800 ABERDEEN ST NE STE 130Blaine, MN 55449-4813
Mailing Address550 County Road D, Suite 12New Brighton, MN 55112 · (651) 259-9902 · Fax (651) 259-9930
Phone(763) 757-2220
Fax(763) 757-9204
Organization SubpartNo
Authorized OfficialKirby Charles JohnsonPresident · (612) 788-9246
Enumeration DateAugust 31, 2006
Last NPPES UpdateJuly 29, 2014
✔ NPI 1467563510 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
11800 ABERDEEN ST NE STE 130, Blaine, MN 55449
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Other Names 1

Doing Business AsOms Specialists

Other Identifiers 4

Medicare UPINC07428MN
Medicare UPINU72187MN
Medicare UPINU72794MN
Medicare UPINT93145MN

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D1010021

Oral And Maxillofacial Surgery Specialists PA · New Brighton, MN
Active · expires Mar 3, 2027
CLIA Number24D1010021
Laboratory TypePractitioner Other
Certificate Effective DateMarch 4, 2025
Certificate Expiration DateMarch 3, 2027
Laboratory DirectorDaniel E. Sampson
Laboratory Phone(612) 788-9246
Laboratory LocationOral And Maxillofacial Surgery Specialists PA550 County Road D Suite 12, New Brighton, MN 55112
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Oral & Maxillofacial Surgery Specialists, PA's NPI number?

The NPI number for Oral & Maxillofacial Surgery Specialists, PA is 1467563510. It was assigned to this organization in the NPPES registry on August 31, 2006. The provider is doing business as Oms Specialists.

Where is Oral & Maxillofacial Surgery Specialists, PA located?

Oral & Maxillofacial Surgery Specialists, PA is located at 11800 Aberdeen St NE Ste 130, Blaine, MN 55449. The listed phone number is (763) 757-2220.

What is Oral & Maxillofacial Surgery Specialists, PA's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Does Oral & Maxillofacial Surgery Specialists, PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D1010021) is associated with this NPI, valid through March 3, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Oral & Maxillofacial Surgery Specialists, PA was last updated on July 29, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.