Provider Demographics
NPI:1073219994
Name:ORAL SURGERY ASSOCIATES OF THE MAIN LINE
Entity Type:Organization
Organization Name:ORAL SURGERY ASSOCIATES OF THE MAIN LINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-716-1714
Mailing Address - Street 1:2 INDUSTRIAL BLVD
Mailing Address - Street 2:BLDG 3 SUITE 125
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1645
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 INDUSTRIAL BLVD
Practice Address - Street 2:BLDG 3 SUITE 125
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1645
Practice Address - Country:US
Practice Address - Phone:610-716-1714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty