Organization
SOUTH PHILADELPHIA ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT MICHAEL WOHAR DMD (PRESIDENT)
(215) 389-2511
Entity
Organization
Contact information
Practice address
1613 SOUTH BROAD ST, PHILIDELPHIA, PA 19148
(215) 389-2511
(215) 389-0334
Mailing address
1613 SOUTH BROAD ST, PHILIDELPHIA, PA 19148
(215) 389-2511
(215) 389-0334
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0317930000
KEYSTONE HEALTH PLAN EAST
PA
01
—
117949
INDEPENCE BLUE CROSS PERS
PA
Enumeration date
08/30/2006
Last updated
08/22/2020
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