Healthcare Provider Details

I. General information

NPI: 1699698936
Provider Name (Legal Business Name): GREATER PHILADELPHIA OMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 TOWNSHIP LINE RD STE C
ELKINS PARK PA
19027-2277
US

IV. Provider business mailing address

401 TOWNSHIP LINE RD STE C
ELKINS PARK PA
19027-2277
US

V. Phone/Fax

Practice location:
  • Phone: 215-379-3382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: CHAD HENDRICKS
Title or Position: CEDENTIALING
Credential:
Phone: 612-859-0444