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General NPI Number Information
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NPI Number | 1568563088
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Entity Type | Organization
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Legal Business Name | BRANDYWINE VALLEY ORAL & MAXIOLLOFACIAL SURGERY
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5279 LINCOLN HWY
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City | GAP
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State | PA
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Zip | 17527-9427
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Country | US
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Telephone | 717-442-9537
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Fax | 717-442-8311
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Provider Business Mailing Address
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Address Line | 5279 LINCOLN HWY
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City | GAP
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State | PA
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Zip | 17527-9427
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Country | US
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Telephone | 717-442-9537
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Fax | 717-442-8311
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. ROBERT D WHITLEY
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Credential | D.D.D.
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Telephone | 717-442-9537
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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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