# DELAWARE VALLEY MAXILLOFACIAL & ORAL SURGERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southeastern Pa Oral Surgery LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073641148
- **Authorized official:** DR. BRIAN M SMITH DMD (CHAIRMAN)
- **Authorized official phone:** (215) 707-7138

## Contact information

- **Practice address:** 2301 E ALLEGHENY AVE STE 206, PHILADELPHIA, PA 19134-4427
- **Practice address phone:** (267) 367-5009
- **Practice address fax:** (267) 367-5476
- **Mailing address:** 100 E LEHIGH AVE, PM2, PHILADELPHIA, PA 19125-1012
- **Mailing address phone:** (215) 707-7138
- **Mailing address fax:** (215) 707-5405

## 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:** 03/01/2007
- **Last updated:** 08/13/2020