Provider Demographics
NPI:1730882291
Name:VENEGAS, OSCAR EDUARDO (DDS, MBA)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:EDUARDO
Last Name:VENEGAS
Suffix:
Gender:M
Credentials:DDS, MBA
Other - Prefix:
Other - First Name:OSCAR
Other - Middle Name:EDUARDO
Other - Last Name:VENEGAS REBOLLEDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MBA
Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-984-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4357-231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery