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General NPI Number Information
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NPI Number | 1285638817
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Entity Type | Organization
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Legal Business Name | POTTSTOWN ORAL & MAXILLOFACIAL SURGERY ASSOC. INC
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Dates
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Enumeration Date | 06/10/2005
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Last Update Date | 04/12/2024
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Provider Practice Location Address
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Address Line | 500 HERITAGE DR
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City | POTTSTOWN
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State | PA
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Zip | 19464-3233
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Country | US
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Telephone | 610-326-7880
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Fax | 610-326-5491
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Provider Business Mailing Address
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Address Line | 500 HERITAGE DR
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City | POTTSTOWN
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State | PA
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Zip | 19464-3233
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Country | US
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Telephone | 610-326-7880
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Fax | 610-326-5491
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL G SMITH
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Credential | DMD
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Telephone | 610-326-7880
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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 | PA
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