NPIMap

Organization Active NPI

Pocono Center for Oral, Facial & Implant Surgery

  • Oral and Maxillofacial Pathology Dentistry
  • Matamoras, PA
National Provider Identifier
1124222971
Registry record updated Sep 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X
License
DS020813L Issued in PA
Legal business name
POCONO CENTER FOR ORAL, FACIAL & IMPLANT SURGERY
Practice address
16 Pennsylvania Ave
Matamoras, PA 18336
Phone
(570) 491-4145
Fax
(570) 491-5119
NPI assigned
Jun 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Pamela Louise Alberto, DMD
Title
Partner
Phone
(570) 491-4145

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DS035287 PA
Oral and Maxillofacial Pathology DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0106X DS020813L PA Primary
Oral and Maxillofacial Pathology DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0106X DS030426L PA

Addresses

Primary practice location

16 Pennsylvania Ave
Matamoras, PA 18336

Mailing address

PO Box 190
16 Pennsylvania Ave
Matamoras, PA 18336
Phone (570) 491-4145

Other names 1

  • Pocono Oral Maxillofacial Surgery Center Former legal business name

National Provider Directory

National Provider Directory

Locations

16 Pennsylvania Ave
Matamoras, PA 18336
Phone (570) 491-4145

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1124222971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190",
            "address_2": "16 PENNSYLVANIA AVE",
            "city": "MATAMORAS",
            "state": "PA",
            "postal_code": "18336",
            "telephone_number": "570-491-4145",
            "fax_number": "570-491-5119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 PENNSYLVANIA AVE",
            "city": "MATAMORAS",
            "state": "PA",
            "postal_code": "18336",
            "telephone_number": "570-491-4145",
            "fax_number": "570-491-5119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POCONO CENTER FOR ORAL, FACIAL & IMPLANT SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "ALBERTO",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "570-491-4145",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS035287",
            "primary": false
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "PA",
            "license": "DS020813L",
            "primary": true
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "PA",
            "license": "DS030426L",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pocono Oral Maxillofacial Surgery Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Matamoras, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.