Provider Demographics
NPI:1104398510
Name:ADVANCED ORAL SURGERY AND IMPLANT CENTER
Entity Type:Organization
Organization Name:ADVANCED ORAL SURGERY AND IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-821-1357
Mailing Address - Street 1:2571 BAGLYOS CIR STE B23
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8051
Mailing Address - Country:US
Mailing Address - Phone:484-821-1357
Mailing Address - Fax:
Practice Address - Street 1:2571 BAGLYOS CIR STE B23
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8051
Practice Address - Country:US
Practice Address - Phone:484-821-1357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEHIGH VALLEY ORAL SURGERY AND IMPLANT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-24
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty