Organization
BALA INSTITUTE OF ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA WAXMAN (OFFICE MANAGER)
(484) 680-6405
Entity
Organization
Contact information
Practice address
15 PRESIDENTIAL BLVD, SUITE 301, BALA CYNWYD, PA 19004-1006
(610) 667-6161
(610) 617-9275
Mailing address
15 N PRESIDENTIAL BOULEVARD, SUITE 301, BALA CYNWYD, PA 19004
(610) 667-6161
(610) 617-9275
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS023126L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1610569
UNITED CONCORDIA
PA
01
—
172847
BLUE SHIELD
PA
01
—
3776353
AETNA
PA
01
—
MA172847
HIGHMARK
PA
Enumeration date
07/29/2006
Last updated
03/04/2022
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