Healthcare Provider Details

I. General information

NPI: 1316908478
Provider Name (Legal Business Name): PETER M FAMIGLIO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 DOWLIN FORGE RD
EXTON PA
19341-1548
US

IV. Provider business mailing address

25 DOWLIN FORGE RD
EXTON PA
19341-1548
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-7000
  • Fax: 610-363-7687
Mailing address:
  • Phone: 610-363-7000
  • Fax: 610-363-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDS026077L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: