Healthcare Provider Details

I. General information

NPI: 1174247951
Provider Name (Legal Business Name): KEITH SILVERSTEIN ORAL & MAXILLOFACIAL SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 INDUSTRIAL BLVD STE 100
PAOLI PA
19301-1610
US

IV. Provider business mailing address

21 INDUSTRIAL BLVD STE 100
PAOLI PA
19301-1610
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-6497
  • Fax:
Mailing address:
  • Phone: 610-644-6497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNULL

VIII. Authorized Official

Name: KEITH SILVERSTEIN
Title or Position: ORAL SURGEON
Credential: DMD, MD
Phone: 610-644-6497