Organization
ADVANCED ORAL AND FACIAL SURGERY OF THE MAIN LINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GODFREY JOEL FUNARI DMD (PRESIDENT)
(610) 688-6683
Entity
Organization
Contact information
Practice address
223 LANCASTER AVENUE, DEVON, PA 19333-1583
(610) 688-6683
(610) 971-0481
Mailing address
223 LANCASTER AVENUE, DEVON, PA 19333-1583
(610) 688-6683
(610) 971-0481
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
DS023425L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720009863
NPI
PA
Enumeration date
04/27/2007
Last updated
08/17/2007
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