Organization
ASSOCIATES IN ORAL & MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDRE BALACI DMD (OWNER PRESIDENT)
(610) 373-7823
Entity
Organization
Contact information
Practice address
955 BERKSHINE BLVD, STE 104, WYOMISSING, PA 19610
(610) 373-7823
(610) 373-5590
Mailing address
955 BERKSHINE BLVD, STE 104, WYOMISSING, PA 19610
(610) 373-7823
(610) 373-5590
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016251970003
—
PA
01
—
02747200
CAPITAL BLUE CROSS
PA
01
—
2208314
AETNA
PA
Enumeration date
11/08/2005
Last updated
10/12/2010
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