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General NPI Number Information
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NPI Number | 1104398510
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Entity Type | Organization
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Legal Business Name | LEHIGH VALLEY ORAL SURGERY AND IMPLANT CENTER, PC
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Dates
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Enumeration Date | 12/24/2018
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 2571 BAGLYOS CIR STE B23
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City | BETHLEHEM
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State | PA
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Zip | 18020-8051
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Country | US
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Telephone | 484-821-1357
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Fax |
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Provider Business Mailing Address
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Address Line | 2571 BAGLYOS CIR STE B23
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City | BETHLEHEM
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State | PA
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Zip | 18020-8051
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Country | US
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Telephone | 484-821-1357
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Fax |
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Authorized Official
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Title or Position | VP, PAYOR RELATIONS
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Name | MICHAELA MUNIZ
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Credential |
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Telephone | 469-324-3242
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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 | NULL
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State | NULL
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