Provider Demographics
NPI:1487659991
Name:ORAL & MAXILLOFACIAL SURGEONS P.C.
Entity Type:Organization
Organization Name:ORAL & MAXILLOFACIAL SURGEONS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-345-7373
Mailing Address - Street 1:101 PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2563
Mailing Address - Country:US
Mailing Address - Phone:215-345-7373
Mailing Address - Fax:215-345-0242
Practice Address - Street 1:101 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2563
Practice Address - Country:US
Practice Address - Phone:215-345-7373
Practice Address - Fax:215-345-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
079295Medicare UPIN