# INNOVATIVE IMPLANT & ORAL SURGERY PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Charles B Nissman DDS, Nissman-Salin Oral & Maxillofacial Surgery PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679547707
- **Authorized official:** MS. DEBRA ROBYN LODISE (OFFICE MANAGER)
- **Authorized official phone:** (215) 322-7810

## Contact information

- **Practice address:** 1300 BRIDGETOWN PIKE, FEASTERVILLE TREVOSE, PA 19053-4326
- **Practice address phone:** (215) 322-7810
- **Practice address fax:** (215) 322-7832
- **Mailing address:** 1300 BRIDGETOWN PIKE, FEASTERVILLE TREVOSE, PA 19053-4326
- **Mailing address phone:** (215) 322-7810
- **Mailing address fax:** (215) 322-7832

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | DS017304L | PA | Yes |
| 174400000X | Specialist | DS030984L | PA | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 02/15/2006
- **Last updated:** 01/23/2026