Provider Demographics
NPI:1134250517
Name:ORAL SURGERY CONSULTANTS OF PENNSYLVANIA PC
Entity type:Organization
Organization Name:ORAL SURGERY CONSULTANTS OF PENNSYLVANIA PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:P
Authorized Official - Last Name:REMENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-463-3916
Mailing Address - Street 1:2546 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4638
Mailing Address - Country:US
Mailing Address - Phone:215-463-4141
Mailing Address - Fax:215-463-7616
Practice Address - Street 1:2546 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4638
Practice Address - Country:US
Practice Address - Phone:215-463-4141
Practice Address - Fax:215-463-7616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030599L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty