Healthcare Provider Details

I. General information

NPI: 1336748870
Provider Name (Legal Business Name): ALBANESE ORAL & MAXILLOFACIAL SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2020
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OLD FORGE LN STE 301
KENNETT SQUARE PA
19348-1897
US

IV. Provider business mailing address

300 OLD FORGE LN STE 301
KENNETT SQUARE PA
19348-1932
US

V. Phone/Fax

Practice location:
  • Phone: 484-926-6001
  • Fax: 484-926-6002
Mailing address:
  • Phone: 484-926-6001
  • Fax: 484-926-6002

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: DR. JAY ALBANESE
Title or Position: OWNER
Credential: DDS, MD
Phone: 484-926-6001