Greater Philadelphia Oral Surgery PC

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

DS019726L Issued in PA

Legal business name

GREATER PHILADELPHIA ORAL SURGERY PC

Practice address

401 Township Line Road
Suite 'C'
Elkins Park, PA 19027

Phone

(215) 379-5520

Fax

(215) 663-5934

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Donna Marie Scott

Title

Office Manager

Phone

(215) 379-3382

Specialties & licenses 1

Addresses

Other names 1

• Mark J. Funt, DMD PC Former legal business name

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 4

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

• Mark J Funt, DMD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Elkins Park, PA
  • NPI 1407945280
  Medicare reassignment NPD
• Robert David Mogyoros, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Elkins Park, PA
  • NPI 1407061161
  Medicare reassignment NPD
• Benjamin Keyser, DMD, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Newton, MA
  • NPI 1194141200
  NPD
• Justin James Kirkwood, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Albany, NY
  • NPI 1700348653
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721779200000",
    "number": "1366549594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 TOWNSHIP LINE ROAD",
            "address_2": "SUITE 'C'",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "19027",
            "telephone_number": "215-379-5520",
            "fax_number": "215-663-5934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 TOWNSHIP LINE ROAD",
            "address_2": "SUITE 'C'",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "19027",
            "telephone_number": "215-379-5520",
            "fax_number": "215-663-5934"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "234 Mall Blvd Ste 180234",
            "address_purpose": "LOCATION",
            "city": "King Of Prussia",
            "state": "PA",
            "postal_code": "194062954",
            "country_code": "US",
            "telephone_number": "484-231-1177",
            "fax_number": "484-231-8964",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GREATER PHILADELPHIA ORAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "215-379-3382"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "PA",
            "license": "DS019726L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mark J. Funt, DMD PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Shelley Z Goodman, PHD
• Surya Gourneni, MD
• Grand Therapy Services, LLC
• Sade K Graves, LCSW
• Greater Philadelphia Oms LLC
• Greater Philadelphia Psychological Associates, PC
• Bethanie M Greco, CRNP
• Lisa A Green, CRNP
• Lawrence Greenberg, M.D.
• Linda Greenberg, MD

• Oral & Maxillofacial Surgery (D.M.D.) in Elkins Park, PA
• Providers in Elkins Park, PA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.