Healthcare Provider Details

I. General information

NPI: 1528024700
Provider Name (Legal Business Name): WYOMISSING ORAL SURGICAL ASSOCS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HEARTHSTONE CT SUITE 301
READING PA
19606-3065
US

IV. Provider business mailing address

6 HEARTHSTONE CT SUITE 301
READING PA
19606-3065
US

V. Phone/Fax

Practice location:
  • Phone: 610-370-2300
  • Fax: 610-370-2303
Mailing address:
  • Phone: 610-370-2300
  • Fax: 610-370-2303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS022591L
License Number StatePA

VIII. Authorized Official

Name: DR. ARTHUR F DOUGLASS JR.
Title or Position: OWNER
Credential: D.D.S.
Phone: 610-370-2300