Healthcare Provider Details

I. General information

NPI: 1396391660
Provider Name (Legal Business Name): A2Z ORAL SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S EASTON RD
GLENSIDE PA
19038-4428
US

IV. Provider business mailing address

201 S EASTON RD
GLENSIDE PA
19038-4428
US

V. Phone/Fax

Practice location:
  • Phone: 215-576-1155
  • Fax: 215-886-3821
Mailing address:
  • Phone: 215-576-1155
  • Fax: 215-886-3821

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: JAANVI BHAGAT
Title or Position: OWNER
Credential:
Phone: 215-237-1525