Healthcare Provider Details

I. General information

NPI: 1083067128
Provider Name (Legal Business Name): WOOD & MYERS ORAL AND MAXILLOFACIAL SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 WALNUT BOTTOM RD STE 305
CARLISLE PA
17013-3632
US

IV. Provider business mailing address

850 WALNUT BOTTOM RD STE 305
CARLISLE PA
17013-3632
US

V. Phone/Fax

Practice location:
  • Phone: 717-462-4555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS030386L
License Number StatePA

VIII. Authorized Official

Name: VANESSA DONATUCCI
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 717-763-1970