Healthcare Provider Details

I. General information

NPI: 1013051374
Provider Name (Legal Business Name): THE FACIAL SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 BESSEMER RD SUITE 302
MOUNT PLEASANT PA
15666-9122
US

IV. Provider business mailing address

220 BESSEMER RD SUITE 302
MOUNT PLEASANT PA
15666-9122
US

V. Phone/Fax

Practice location:
  • Phone: 724-547-0999
  • Fax: 724-547-5345
Mailing address:
  • Phone: 724-547-0999
  • Fax: 724-547-5345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS021856L .DS027205L
License Number StatePA

VIII. Authorized Official

Name: DR. EDWARD J. HALUSIC JR.
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 724-547-0999