Provider Demographics
NPI:1982669743
Name:ORAL SURGERY ASSOC.,LTD
Entity Type:Organization
Organization Name:ORAL SURGERY ASSOC.,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:P
Authorized Official - Last Name:BORGHESANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-688-6682
Mailing Address - Street 1:223 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1583
Mailing Address - Country:US
Mailing Address - Phone:610-688-6682
Mailing Address - Fax:610-971-0481
Practice Address - Street 1:223 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1583
Practice Address - Country:US
Practice Address - Phone:610-688-6682
Practice Address - Fax:610-971-0481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15594L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0026814000OtherKEYSTONE
PA405476OtherBLUES OTHER
PA4451977OtherAETNA
PA4451977OtherAETNA