Provider Demographics
NPI:1033283841
Name:QUAD COUNTY ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:QUAD COUNTY ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-282-6100
Mailing Address - Street 1:114 EAST DIMOND ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-5906
Mailing Address - Country:US
Mailing Address - Phone:724-282-6100
Mailing Address - Fax:724-282-7701
Practice Address - Street 1:114 EAST DIMOND ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5906
Practice Address - Country:US
Practice Address - Phone:724-282-6100
Practice Address - Fax:724-282-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020150L204E00000X
PADS029596L204E00000X
PADS019428L204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
QU889312OtherHIGHMARK
QU889312OtherUNITED CONCORDIA