Healthcare Provider Details

I. General information

NPI: 1932912631
Provider Name (Legal Business Name): ASSOCIATED ORAL & MAXILLOFACIAL SURGEONS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 OPAL CT
HAGERSTOWN MD
21740-5940
US

IV. Provider business mailing address

1144 OPAL CT
HAGERSTOWN MD
21740-5940
US

V. Phone/Fax

Practice location:
  • Phone: 301-733-2500
  • Fax: 301-733-9600
Mailing address:
  • Phone: 301-733-2500
  • Fax: 301-733-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: PAMELA PHILLIPS
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-263-0991