Provider Demographics
NPI:1447388590
Name:ORAL AND MAXILLO-FACIAL SURGERY, INC.
Entity Type:Organization
Organization Name:ORAL AND MAXILLO-FACIAL SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-234-0921
Mailing Address - Street 1:432 ROLLING RIDGE DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801
Mailing Address - Country:US
Mailing Address - Phone:814-234-0921
Mailing Address - Fax:814-234-6240
Practice Address - Street 1:432 ROLLING RIDGE DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-234-0921
Practice Address - Fax:814-234-6240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017187L1223X0008X
PADS024017L1223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Single Specialty