# BALA INSTITUTE OF ORAL SURGERY

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

## Provider details

- **NPI number:** 1477567782
- **Authorized official:** LISA WAXMAN (OFFICE MANAGER)
- **Authorized official phone:** (484) 680-6405

## Contact information

- **Practice address:** 15 PRESIDENTIAL BLVD, SUITE 301, BALA CYNWYD, PA 19004-1006
- **Practice address phone:** (610) 667-6161
- **Practice address fax:** (610) 617-9275
- **Mailing address:** 15 N PRESIDENTIAL BOULEVARD, SUITE 301, BALA CYNWYD, PA 19004
- **Mailing address phone:** (610) 667-6161
- **Mailing address fax:** (610) 617-9275

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DS023126L | PA | Yes |

## Other

- **Enumeration date:** 07/29/2006
- **Last updated:** 03/04/2022