Provider Demographics
NPI:1265645618
Name:ORALFACIAL DENTAL IMPLANT SURGERY CENTER
Entity Type:Organization
Organization Name:ORALFACIAL DENTAL IMPLANT SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:PAOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-459-4179
Mailing Address - Street 1:871 BALTIMORE PIKE
Mailing Address - Street 2:UNIT 15
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342
Mailing Address - Country:US
Mailing Address - Phone:610-459-4179
Mailing Address - Fax:610-459-9242
Practice Address - Street 1:871 BALTIMORE PIKE
Practice Address - Street 2:UNIT 15
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342
Practice Address - Country:US
Practice Address - Phone:610-459-4179
Practice Address - Fax:610-459-9242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty