Healthcare Provider Details

I. General information

NPI: 1073219994
Provider Name (Legal Business Name): ORAL SURGERY ASSOCIATES OF THE MAIN LINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 INDUSTRIAL BLVD BLDG 3 SUITE 125
PAOLI PA
19301-1645
US

IV. Provider business mailing address

2 INDUSTRIAL BLVD BLDG 3 SUITE 125
PAOLI PA
19301-1645
US

V. Phone/Fax

Practice location:
  • Phone: 610-716-1714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH LEONETTI
Title or Position: OWNER
Credential: DDS
Phone: 610-716-1714