| Shenandoah Oral & Maxillofacial Surgery Inc | |
|
170 Garber Ln Winchester VA 22602-4386 | |
| (540) 667-0100 | |
| (540) 667-0121 |
| Full Name | Shenandoah Oral & Maxillofacial Surgery Inc |
|---|---|
| Speciality | Dentist |
| Location | 170 Garber Ln, Winchester, Virginia |
| Authorized Official Name and Position | Tara Ann Fugate (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 7038978983 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shenandoah Oral & Maxillofacial Surgery Inc 170 Garber Ln Winchester VA 22602-4386 Ph: (540) 667-0100 | Shenandoah Oral & Maxillofacial Surgery Inc 170 Garber Ln Winchester VA 22602-4386 Ph: (540) 667-0100 |
| NPI Number | 1972940393 |
|---|---|
| Provider Enumeration Date | 05/24/2013 |
| Last Update Date | 09/18/2019 |
| Medicare PECOS PAC ID | 5092045922 |
|---|---|
| Medicare Enrollment ID | O20190919001266 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972940393 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 0401006414 (Virginia) | Primary |
| Provider Name | James A Pell |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1598738338 PECOS PAC ID: 0244253128 Enrollment ID: I20171120003188 |
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