Provider Demographics
NPI:1114558103
Name:EAGLES ORAL SURGERY
Entity Type:Organization
Organization Name:EAGLES ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY CONTROL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-372-6313
Mailing Address - Street 1:1301 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2140
Mailing Address - Country:US
Mailing Address - Phone:484-773-1717
Mailing Address - Fax:484-773-1717
Practice Address - Street 1:1001 S 4TH ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526-9211
Practice Address - Country:US
Practice Address - Phone:484-773-1717
Practice Address - Fax:484-773-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty