Healthcare Provider Details

I. General information

NPI: 1669656088
Provider Name (Legal Business Name): ASSOCIATES IN ORAL AND MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 W CHESTNUT ST SUITE #125 LL
WASHINGTON PA
15301-4524
US

IV. Provider business mailing address

90 W CHESTNUT ST SUITE #125 LL
WASHINGTON PA
15301-4524
US

V. Phone/Fax

Practice location:
  • Phone: 724-222-3422
  • Fax:
Mailing address:
  • Phone: 724-222-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberAS1691395
License Number StatePA

VIII. Authorized Official

Name: SHERMAN SPATZ
Title or Position: PRESIDENT
Credential:
Phone: 724-222-3422