Provider Demographics
NPI:1376761551
Name:BRANDYWINE DENTAL IMPLANTS AND ORAL & MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:BRANDYWINE DENTAL IMPLANTS AND ORAL & MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:FAMIGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-363-7000
Mailing Address - Street 1:25 DOWLIN FORGE RD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1548
Mailing Address - Country:US
Mailing Address - Phone:610-363-7000
Mailing Address - Fax:
Practice Address - Street 1:25 DOWLIN FORGE RD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1548
Practice Address - Country:US
Practice Address - Phone:610-363-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026077L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty