Healthcare Provider Details

I. General information

NPI: 1639210198
Provider Name (Legal Business Name): BAMONTE ORAL SURGERY CRNA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N MEADOWS DR SUITE #121
WEXFORD PA
15090-8368
US

IV. Provider business mailing address

101 N MEADOWS DR SUITE #121
WEXFORD PA
15090-8368
US

V. Phone/Fax

Practice location:
  • Phone: 724-394-3844
  • Fax: 724-394-3851
Mailing address:
  • Phone: 724-394-3844
  • Fax: 724-394-3851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS024033L
License Number StatePA

VIII. Authorized Official

Name: DR. JOHN A BAMONTE
Title or Position: OWNER
Credential: DMD
Phone: 724-934-3844