Provider Demographics
NPI:1629020771
Name:ORAL AND MAXILLOFACIAL SURGERY, LTD.
Entity Type:Organization
Organization Name:ORAL AND MAXILLOFACIAL SURGERY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:QUEALE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-837-7770
Mailing Address - Street 1:31 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2503
Mailing Address - Country:US
Mailing Address - Phone:724-837-7770
Mailing Address - Fax:724-838-7731
Practice Address - Street 1:31 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2503
Practice Address - Country:US
Practice Address - Phone:724-837-7770
Practice Address - Fax:724-838-7731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty