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General NPI Number Information
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NPI Number | 1588625628
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Entity Type | Organization
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Legal Business Name | CENTRAL PA ORAL AND MAXILLOFACIAL SURGEONS
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 4700 UNION DEPOSIT RD SUITE 260
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City | HARRISBURG
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State | PA
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Zip | 17111-3774
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Country | US
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Telephone | 717-540-1777
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Fax | 717-540-6857
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Provider Business Mailing Address
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Address Line | 4700 UNION DEPOSIT RD SUITE 260
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City | HARRISBURG
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State | PA
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Zip | 17111-3774
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Country | US
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Telephone | 717-540-1777
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Fax | 717-540-6857
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Authorized Official
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Title or Position | FINANCIAL/INSURANCE MANAGER
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Name | TAMMI HAMMAKER
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Credential |
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Telephone | 717-909-3239
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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 | DS020467L
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License Number State | PA
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