Organization Active NPI

Associates in Oral & Maxillofacial Surgery

  • Oral and Maxillofacial Surgery Clinic/Center
  • Wyomissing, PA
National Provider Identifier
1386625366
Registry record updated Oct 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
Legal business name
ASSOCIATES IN ORAL & MAXILLOFACIAL SURGERY
Practice address
955 Berkshine Blvd
Ste 104
Wyomissing, PA 19610
Phone
(610) 373-7823
Fax
(610) 373-5590
NPI assigned
Nov 8, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2010

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

Authorized official

Name
Alexandre Balaci, DMD
Title
Owner President
Phone
(610) 373-7823

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X Primary

Addresses

Primary practice location

955 Berkshine Blvd
Ste 104
Wyomissing, PA 19610

Mailing address

955 Berkshine Blvd
Ste 104
Wyomissing, PA 19610
Phone (610) 373-7823

Other identifiers 3

IdentifierTypeStateIssuer
02747200OtherPACAPITAL BLUE CROSS
0016251970003MedicaidPA
2208314OtherPAAETNA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1131408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286841600000",
    "number": "1386625366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 BERKSHINE BLVD",
            "address_2": "STE 104",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "19610",
            "telephone_number": "610-373-7823",
            "fax_number": "610-373-5590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 BERKSHINE BLVD",
            "address_2": "STE 104",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "19610",
            "telephone_number": "610-373-7823",
            "fax_number": "610-373-5590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATES IN ORAL & MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-08",
        "last_updated": "2010-10-12",
        "status": "A",
        "authorized_official_last_name": "BALACI",
        "authorized_official_first_name": "ALEXANDRE",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "610-373-7823",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "02747200",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0016251970003",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2208314",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyomissing, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2010; 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.