DELAWARE VALLEY MAXILLOFACIAL & ORAL SURGERY LLC (NPI# 1073641148) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073641148 |
| Entity Type | Organization |
| Organization Name | DELAWARE VALLEY MAXILLOFACIAL & ORAL SURGERY LLC |
| Other Organization Name | SOUTHEASTERN PA ORAL SURGERY LLC |
| Practice Address |
2301 E Allegheny Ave Ste 206 Philadelphia PA 19134-4427 |
| Mailing Address |
100 E Lehigh Ave Pm2 Philadelphia PA 19125-1012 |
| Practice Telephone | 2673675009 |
| Practice Fax Number | 2673675476 |
| Mailing Telephone | 2157077138 |
| Mailing Fax Number | 2157075405 |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-08-13 |
| Authorized Official Name | DR. BRIAN M SMITH (CHAIRMAN) |
| Authorized Official Telephone | 2157077138 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Southeastern Pa Oral Surgery LLC | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 100 E Lehigh Ave, Pm2, Philadelphia, PA 191251012 | 2157077138 | 2157075405 |
| Street Address |
2301 E ALLEGHENY AVE STE 206 |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19134-4427 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871137208 | My Philadelphia Pharmacy Inc | Pharmacy | 2901 E Thompson St, Front Store, Philadelphia, PA 19134 | 2019-10-29 |
| 1588125793 | Bret Johnson | Student in an Organized Health Care Education/Training Program | Pediatric Residency Program, 160 East Erie Ave, Philadelphia, PA 19134 | 2019-03-29 |
| 1053881672 | Ana Y Almanzar | Psychologist | 3513 North Water Street, Philadelphia, PA 19134 | 2018-11-27 |
| 1861974206 | Stephanie C Curtis | Registered Nurse | St. Christopher's Hospital for Children 160 E Erie Ave, Philadelphia, PA 19134 | 2018-09-01 |
| 1700371978 | Kristi Ford | Nurse Practitioner | 160 E Erie Ave # 21542, Philadelphia, PA 19134 | 2018-06-28 |
| 1700370178 | Natalie Martinez | Case Manager/Care Coordinator | 3528 I St Ste 1, Philadelphia, PA 19134 | 2018-06-19 |
| 1205352309 | Personal Injury Clinic PC | Chiropractor | 2301 E Allegheny Ave Ste 305a, Philadelphia, PA 19134 | 2017-08-21 |
| 1306376280 | Port Richmond Counseling Practices | Clinic/Center | 3110 Aramingo Ave, Suite 1, Philadelphia, PA 19134 | 2017-06-14 |
| 1760864441 | Jason Roy Toews | Pediatrics | 160 East Eire Ave, St. Christopher's Hospital for Children, Philadelphia, PA 19134 | 2015-06-18 |
| 1376933291 | David Tanney Yusavitz | Nurse Practitioner | 160 E Erie Ave Ste 2015, Philadelphia, PA 19134 | 2015-01-30 |
| Find all providers in zip 19134 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528626124 | Christopher Yi | Dentist | 900 Walnut St Rm 300, Philadelphia, PA 19107-5191 | 2019-05-30 |
| 1962942771 | American Management Group | Dentist | 3900 City Avenue Apt W1101, Philadelphia, PA 19131 | 2017-02-27 |
| 1457771545 | Diana Lin | Dentist | 2630 Holme Ave Ste 103, Philadelphia, PA 19152-3004 | 2014-04-16 |
| 1245554385 | Bryant Jones | Dentist | 8957 Roosevelt Blvd, Philadelphia, PA 19152-1312 | 2010-03-18 |
| 1962601773 | Daniel J Bowser | Dentist | 2327 Cottman Ave, Philadelphia, PA 19149-1008 | 2007-07-12 |
| 1396969036 | Franklyn Scott, D.d.s., P.C. | Dentist | 900 East Wadsworth Avenue, Philadelphia, PA 19150 | 2007-04-12 |
| 1598805608 | Franklyn Scott | Dentist | 900 E Wadsworth Ave, Philadelphia, PA 19150-3417 | 2007-02-07 |
| 1881796985 | Ramin Bahram | Dentist | 2546 S Broad St, Philadelphia, PA 19145-4638 | 2006-09-01 |
| 1255381513 | Michael T Dachowski | Dentist | 2630 Holme Avenue, Suite 103, Philadelphia, PA 19152-1912 | 2006-05-10 |
| 1699732602 | Mehran Hossainizadeh | Dentist | 3223 N. Broad Street, Philadelphia, PA 19140 | 2006-04-26 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19134 |
Please comment or provide details below to improve the information on DELAWARE VALLEY MAXILLOFACIAL & ORAL SURGERY LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.