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Organization
UNIVERSITY OF PENN - ORAL SURGERY ASSOCIATES
Active
Organization
UNIVERSITY OF PENN - ORAL SURGERY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH JOHNSTON (EXECUTIVE DIRECTOR)
(215) 662-7583
Entity
Organization
Contact information
Practice address
3400 SPRUCE ST, 5 WHITE BUILDING, PHILADELPHIA, PA 19104-4206
(215) 662-3580
(215) 662-7445
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-2286
(215) 615-0500
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
08/19/2006
Last updated
01/06/2014
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