| Suburban Oral Surgery, Pc | |
|
2010 W Chester Pike Suite 128 Havertown PA 19083-2700 | |
| (610) 449-2100 | |
| (610) 449-9415 |
| Full Name | Suburban Oral Surgery, Pc |
|---|---|
| Speciality | Dentist |
| Location | 2010 W Chester Pike, Havertown, Pennsylvania |
| Authorized Official Name and Position | Alfred John Wolanin (PRESIDENT) |
| Authorized Official Contact | 6104492100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Suburban Oral Surgery, Pc 2010 W Chester Pike Suite 128 Havertown PA 19083-2700 Ph: (610) 449-2100 | Suburban Oral Surgery, Pc 2010 W Chester Pike Suite 128 Havertown PA 19083-2700 Ph: (610) 449-2100 |
| NPI Number | 1952356073 |
|---|---|
| Provider Enumeration Date | 05/24/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 8921094749 |
|---|---|
| Medicare Enrollment ID | O20040426000278 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952356073 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | John D Bradford |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1750328498 PECOS PAC ID: 8325059884 Enrollment ID: I20060511000366 |
| Provider Name | Alfred Wolanin |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1801841101 PECOS PAC ID: 9830171016 Enrollment ID: I20150501001181 |
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