Healthcare Provider Details

I. General information

NPI: 1346310505
Provider Name (Legal Business Name): ASSOCIATED ORAL & MAXILLOFACIAL SURGEONS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 SUSHRUTA DRIVE
MARTINSBURG WV
25401
US

IV. Provider business mailing address

1007 SUSHRUTA DRIVE
MARTINSBURG WV
25401
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-0991
  • Fax: 304-274-9546
Mailing address:
  • Phone: 304-263-0991
  • Fax: 304-274-9546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAMELA PHILLIPS
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-263-0991