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General NPI Number Information
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NPI Number | 1043496599
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Entity Type | Organization
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Legal Business Name | MONTCO ORAL AND MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 545 W MAIN ST SUITE 24
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City | TRAPPE
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State | PA
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Zip | 19426-1981
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Country | US
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Telephone | 610-489-0525
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Fax | 610-489-4720
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Provider Business Mailing Address
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Address Line | 545 W MAIN ST SUITE 24
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City | TRAPPE
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State | PA
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Zip | 19426-1981
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Country | US
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Telephone | 610-489-0525
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Fax | 610-489-4720
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARY E LUKAS
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Credential |
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Telephone | 610-489-0525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS024305
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License Number State | PA
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