Organization
INNOVATIVE IMPLANT & ORAL SURGERY PC
Active
Other names
Charles B Nissman DDS, Nissman-Salin Oral & Maxillofacial Surgery PC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBRA ROBYN LODISE (OFFICE MANAGER)
(215) 322-7810
Entity
Organization
Contact information
Practice address
1300 BRIDGETOWN PIKE, FEASTERVILLE TREVOSE, PA 19053-4326
(215) 322-7810
(215) 322-7832
Mailing address
1300 BRIDGETOWN PIKE, FEASTERVILLE TREVOSE, PA 19053-4326
(215) 322-7810
(215) 322-7832
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
DS017304L
PA
174400000X
Specialist
DS030984L
PA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0547613000
KEYST GROUP#
PA
01
—
161558
NISSMAN BLUE SHIELD
PA
01
—
1615888
SALIN BLUE SHIELD
PA
01
—
4437
AETNA NISSMAN
PA
01
—
747908
BLUE SHIELD GROUP#
PA
Enumeration date
02/15/2006
Last updated
01/23/2026
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