# PA ORAL FACIAL & IMPLANT SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063801397
- **Authorized official:** MRS. BARBARA SPOHN (OFFICE MANAGER)
- **Authorized official phone:** (814) 375-0500

## Contact information

- **Practice address:** 90 BEAVER DR, SUITE 101A, DU BOIS, PA 15801-2440
- **Practice address phone:** (814) 375-0500
- **Practice address fax:** (814) 375-0124
- **Mailing address:** 90 BEAVER DR, SUITE 101A, DU BOIS, PA 15801-2440
- **Mailing address phone:** (814) 375-0500
- **Mailing address fax:** (814) 375-0124

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 01/09/2015
- **Last updated:** 01/09/2015