# SUBURBAN ORAL SURGERY, PC

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

## Provider details

- **NPI number:** 1952356073
- **Authorized official:** DR. ALFRED JOHN WOLANIN JR. DDS (PRESIDENT)
- **Authorized official phone:** (610) 449-2100

## Contact information

- **Practice address:** 2010 W CHESTER PIKE, SUITE 128, HAVERTOWN, PA 19083-2700
- **Practice address phone:** (610) 449-2100
- **Practice address fax:** (610) 449-9415
- **Mailing address:** 2010 W CHESTER PIKE, SUITE 128, HAVERTOWN, PA 19083-2700
- **Mailing address phone:** (610) 449-2100
- **Mailing address fax:** (610) 449-9415

## 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:** 05/24/2006
- **Last updated:** 08/22/2020