# MAXILLA LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PA ORAL SURGERY LTD
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1942082250
- **Legal business name:** PA ORAL SURGERY LTD
- **Authorized official:** DR. MICHAEL BIANCHI DDS, FACS (PRESIDENT)
- **Authorized official phone:** (610) 527-3110

## Contact information

- **Practice address:** 555 SECOND AVE STE E-100, COLLEGEVILLE, PA 19426-3622
- **Practice address phone:** (610) 409-9660
- **Mailing address:** 26 S BRYN MAWR AVE, BRYN MAWR, PA 19010-3201
- **Mailing address phone:** (610) 527-3110

## 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:** 10/20/2023
- **Last updated:** 10/20/2023