Healthcare Provider Details

I. General information

NPI: 1982669743
Provider Name (Legal Business Name): ORAL SURGERY ASSOC.,LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 W LANCASTER AVE
DEVON PA
19333-1583
US

IV. Provider business mailing address

223 W LANCASTER AVE
DEVON PA
19333-1583
US

V. Phone/Fax

Practice location:
  • Phone: 610-688-6682
  • Fax: 610-971-0481
Mailing address:
  • Phone: 610-688-6682
  • Fax: 610-971-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number15594L
License Number StatePA

VIII. Authorized Official

Name: DR. EVERETT P. BORGHESANI
Title or Position: PRESIDENT
Credential: DDS
Phone: 610-688-6682