Healthcare Provider Details

I. General information

NPI: 1972602621
Provider Name (Legal Business Name): LOFTUS-MERMER ORAL SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 ACADEMY RD SUITE 203
PHILADELPHIA PA
19114-1120
US

IV. Provider business mailing address

10101 ACADEMY RD SUITE 203
PHILADELPHIA PA
19114-1120
US

V. Phone/Fax

Practice location:
  • Phone: 215-281-3400
  • Fax: 215-281-3477
Mailing address:
  • Phone: 215-281-3400
  • Fax: 215-281-3477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT W MERMER
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 215-281-3400