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General NPI Number Information
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NPI Number | 1922043322
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Entity Type | Organization
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Legal Business Name | VALLEY ORAL SURGEON, LTD.
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20 OSBORNE ST
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City | JOHNSTOWN
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State | PA
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Zip | 15905-4128
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Country | US
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Telephone | 814-536-4675
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Fax | 814-536-8897
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Provider Business Mailing Address
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Address Line | 20 OSBORNE ST
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City | JOHNSTOWN
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State | PA
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Zip | 15905-4128
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Country | US
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Telephone | 814-536-4675
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Fax | 814-536-8897
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL L.. DELROSARIO
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Credential | D.D.S.
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Telephone | 814-536-4675
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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 | DS028079L
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License Number State | PA
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