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General NPI Number Information
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NPI Number | 1376761551
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Entity Type | Organization
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Legal Business Name | BRANDYWINE DENTAL IMPLANTS AND ORAL & MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 25 DOWLIN FORGE RD
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City | EXTON
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State | PA
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Zip | 19341-1548
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Country | US
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Telephone | 610-363-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 25 DOWLIN FORGE RD
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City | EXTON
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State | PA
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Zip | 19341-1548
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Country | US
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Telephone | 610-363-7000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER M FAMIGLIO
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Credential | DMD
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Telephone | 610-363-7000
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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 | DS026077L
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License Number State | PA
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