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Organization

CENTRAL PA ORAL AND MAXILLOFACIAL SURGEONS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TAMMI HAMMAKER (FINANCIAL/INSURANCE MANAGER)
(717) 909-3239
Entity
Organization

Contact information

Practice address
4700 UNION DEPOSIT RD, SUITE 260, HARRISBURG, PA 17111-3774
(717) 540-1777
(717) 540-6857
Mailing address
4700 UNION DEPOSIT RD, SUITE 260, HARRISBURG, PA 17111-3774
(717) 540-1777
(717) 540-6857

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS020467L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
02438800
CB PROVIDER ID NUMBER
PA
01
484988
AETNA PROVIDER NUMBER
PA
Enumeration date
03/29/2006
Last updated
08/07/2008
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