Provider Demographics
NPI:1629123229
Name:MAXILLO FACIAL SURGEONS LTD
Entity Type:Organization
Organization Name:MAXILLO FACIAL SURGEONS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:ROMESBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-353-1404
Mailing Address - Street 1:3501 W CHESTER PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3704
Mailing Address - Country:US
Mailing Address - Phone:610-353-1404
Mailing Address - Fax:610-353-1083
Practice Address - Street 1:3501 W CHESTER PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3704
Practice Address - Country:US
Practice Address - Phone:610-353-1404
Practice Address - Fax:610-353-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-016814-L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty