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General NPI Number Information
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NPI Number | 1639210198
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Entity Type | Organization
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Legal Business Name | BAMONTE ORAL SURGERY CRNA
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 101 N MEADOWS DR SUITE #121
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City | WEXFORD
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State | PA
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Zip | 15090-8368
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Country | US
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Telephone | 724-394-3844
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Fax | 724-394-3851
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Provider Business Mailing Address
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Address Line | 101 N MEADOWS DR SUITE #121
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City | WEXFORD
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State | PA
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Zip | 15090-8368
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Country | US
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Telephone | 724-394-3844
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Fax | 724-394-3851
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN A BAMONTE
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Credential | DMD
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Telephone | 724-934-3844
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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 | DS024033L
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License Number State | PA
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