Healthcare Provider Details

I. General information

NPI: 1871764860
Provider Name (Legal Business Name): THE FACIAL SURGERY CENTER, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 ROUTE 819 STE 100
MT PLEASANT PA
15666-2665
US

IV. Provider business mailing address

6545 ROUTE 819 STE 100
MT PLEASANT PA
15666-2665
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 NumberDS021856
License Number StatePA

VIII. Authorized Official

Name: DR. EDWARD JOHN HALUSIC
Title or Position: OWNER/ORAL, MAXILLOFACIAL SURGEON
Credential: D.M.D.
Phone: 724-547-0999