Active NPI
Associates in Oral & Maxillofacial Surgery
- Oral and Maxillofacial Surgery Clinic/Center
- Wyomissing, PA
National Provider Identifier
1386625366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery Clinic/Center
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02747200 | Other | PA | CAPITAL BLUE CROSS |
| 0016251970003 | Medicaid | PA | |
| 2208314 | Other | PA | AETNA |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Oral and Maxillofacial Surgery (Dentist)
- Harrisburg, PA
- NPI 1184636490
-
- Oral and Maxillofacial Surgery (Dentist)
- Pottsville, PA
- NPI 1649251570
Single Specialty
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.