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Organization
MAXILLA LLC
Active
Organization
MAXILLA LLC
Active
Parent organization
PA ORAL SURGERY LTD
Organization subpart
Yes
Provider details
NPI number
Legal business name
PA ORAL SURGERY LTD
Authorized official
DR. MICHAEL BIANCHI DDS, FACS (PRESIDENT)
(610) 527-3110
Entity
Organization
Contact information
Practice address
555 SECOND AVE STE E-100, COLLEGEVILLE, PA 19426-3622
(610) 409-9660
Mailing address
26 S BRYN MAWR AVE, BRYN MAWR, PA 19010-3201
(610) 527-3110
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
10/20/2023
Last updated
10/20/2023
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