| South Philadelphia Oral And Maxillofacial Surgery Associates Pc | |
|
1613 South Broad St Philidelphia PA 19148 | |
| (215) 389-2511 | |
| (215) 389-0334 |
| Full Name | South Philadelphia Oral And Maxillofacial Surgery Associates Pc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1613 South Broad St, Philidelphia, Pennsylvania |
| Authorized Official Name and Position | Robert Michael Wohar (PRESIDENT) |
| Authorized Official Contact | 2153892511 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Philadelphia Oral And Maxillofacial Surgery Associates Pc 1613 South Broad St Philidelphia PA 19148 Ph: (215) 389-2511 | South Philadelphia Oral And Maxillofacial Surgery Associates Pc 1613 South Broad St Philidelphia PA 19148 Ph: (215) 389-2511 |
| NPI Number | 1952411720 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952411720 | NPI | - | NPPES |
| 0317930000 | Other | PA | KEYSTONE HEALTH PLAN EAST |
| 117949 | Other | PA | INDEPENCE BLUE CROSS PERS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |