Healthcare Provider Details

I. General information

NPI: 1518983121
Provider Name (Legal Business Name): ORAL & MAXILLOFACIAL SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N BROAD ST STE 106
LANSDALE PA
19446-1052
US

IV. Provider business mailing address

2100 N BROAD ST STE 106
LANSDALE PA
19446-1052
US

V. Phone/Fax

Practice location:
  • Phone: 215-368-8104
  • Fax: 215-368-3711
Mailing address:
  • Phone: 215-368-8104
  • Fax: 215-368-3711

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: ROGER PAUL SPAMPATA
Title or Position: OWNER
Credential: D.M.D
Phone: 215-368-8104