Provider Demographics
NPI:1528024700
Name:WYOMISSING ORAL SURGICAL ASSOCS, LTD
Entity Type:Organization
Organization Name:WYOMISSING ORAL SURGICAL ASSOCS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:F
Authorized Official - Last Name:DOUGLASS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-370-2300
Mailing Address - Street 1:6 HEARTHSTONE CT
Mailing Address - Street 2:SUITE 301
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3065
Mailing Address - Country:US
Mailing Address - Phone:610-370-2300
Mailing Address - Fax:610-370-2303
Practice Address - Street 1:6 HEARTHSTONE CT
Practice Address - Street 2:SUITE 301
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3065
Practice Address - Country:US
Practice Address - Phone:610-370-2300
Practice Address - Fax:610-370-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022591L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011843970002Medicaid
PA0011843970002Medicaid