Provider Demographics
NPI:1518983121
Name:ORAL & MAXILLOFACIAL SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:ORAL & MAXILLOFACIAL SURGICAL ASSOCIATES
Other - Org Name:ORAL AND MAXILLOFACIAL SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SPAMPATA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-368-8104
Mailing Address - Street 1:2100 N BROAD ST
Mailing Address - Street 2:STE 106
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1052
Mailing Address - Country:US
Mailing Address - Phone:215-368-8104
Mailing Address - Fax:215-368-3711
Practice Address - Street 1:2100 N BROAD ST
Practice Address - Street 2:STE 106
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1052
Practice Address - Country:US
Practice Address - Phone:215-368-8104
Practice Address - Fax:215-368-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty