Organization
SUBURBAN ORAL SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD JAMES CLARK III DDS (PRESIDENT)
(610) 513-9137
Entity
Organization
Contact information
Practice address
2300 GARRETT ROAD, DREXEL HILL, PA 19026-1102
(610) 623-4211
(610) 623-2850
Mailing address
2300 GARRETT ROAD, DREXEL HILL, PA 19026-1102
(610) 623-4211
(610) 623-2850
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
02/18/2021
Last updated
02/18/2021
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