Provider Demographics
NPI:1942082250
Name:MAXILLA LLC
Entity Type:Organization
Organization Name:MAXILLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, FACS
Authorized Official - Phone:610-527-3110
Mailing Address - Street 1:26 S BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3201
Mailing Address - Country:US
Mailing Address - Phone:610-527-3110
Mailing Address - Fax:
Practice Address - Street 1:555 SECOND AVE STE E-100
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3622
Practice Address - Country:US
Practice Address - Phone:610-409-9660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PA ORAL SURGERY LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty