Provider Demographics
NPI:1700235538
Name:WOOD & MYERS ORAL AND MAXILLOFACIAL SURGERY, PC
Entity Type:Organization
Organization Name:WOOD & MYERS ORAL AND MAXILLOFACIAL SURGERY, PC
Other - Org Name:WOOD & MYERS ORAL & MAXILLOFACIAL SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONATUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-763-1970
Mailing Address - Street 1:4341 LINGLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-9531
Mailing Address - Country:US
Mailing Address - Phone:717-545-6200
Mailing Address - Fax:717-545-1373
Practice Address - Street 1:4341 LINGLESTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-9531
Practice Address - Country:US
Practice Address - Phone:717-545-6200
Practice Address - Fax:717-545-1373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030386L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty