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General NPI Number Information
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NPI Number | 1063801397
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Entity Type | Organization
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Legal Business Name | PA ORAL FACIAL & IMPLANT SURGERY
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 90 BEAVER DR SUITE 101A
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City | DU BOIS
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State | PA
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Zip | 15801-2440
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Country | US
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Telephone | 814-375-0500
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Fax | 814-375-0124
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Provider Business Mailing Address
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Address Line | 90 BEAVER DR SUITE 101A
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City | DU BOIS
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State | PA
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Zip | 15801-2440
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Country | US
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Telephone | 814-375-0500
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Fax | 814-375-0124
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. BARBARA SPOHN
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Credential |
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Telephone | 814-375-0500
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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 |
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License Number State |
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