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General NPI Number Information
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NPI Number | 1295348258
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Entity Type | Organization
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Legal Business Name | EXTON ORAL SURGERY LLC
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 670 W LINCOLN HWY
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City | EXTON
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State | PA
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Zip | 19341-2514
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Country | US
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Telephone | 610-228-2391
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Fax |
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Provider Business Mailing Address
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Address Line | 201 S EASTON RD
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City | GLENSIDE
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State | PA
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Zip | 19038-4428
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Country | US
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Telephone | 610-228-2391
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JAANVI BHAGAT
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Credential |
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Telephone | 215-237-3335
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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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