Healthcare Provider Details

I. General information

NPI: 1821954405
Provider Name (Legal Business Name): ARCH ORAL SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 SKIPPACK PIKE
BLUE BELL PA
19422-1580
US

IV. Provider business mailing address

902 SKIPPACK PIKE
BLUE BELL PA
19422-1580
US

V. Phone/Fax

Practice location:
  • Phone: 215-774-1066
  • Fax: 215-774-1085
Mailing address:
  • Phone: 215-774-1066
  • Fax: 215-774-1085

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: JENNIFER HERITAGE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 402-805-4516