Bala Institute of Oral Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DS023126L Issued in PA

Legal business name

BALA INSTITUTE OF ORAL SURGERY

Practice address

15 Presidential Blvd
Suite 301
Bala Cynwyd, PA 19004-1006

Phone

(610) 667-6161

Fax

(610) 617-9275

NPI assigned

Jul 29, 2006

Organization subpart

No

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

Authorized official

Name

Lisa Waxman

Title

Office Manager

Phone

(484) 680-6405

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 3

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

• Mansoor Madani, DMD

  • Dentist
  • Bala Cynwyd, PA
  • NPI 1568646628

  NJ

  Medicare reassignment NPD
• Rebecca Michael

  • Pharmacy Technician
  • Plymouth Meeting, PA
  • NPI 1891931739
  NPD
• Farideh M Madani, DMD

  • Dentist
  • Bala Cynwyd, PA
  • NPI 1871892844
  NPD (past)

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646352000000",
    "number": "1477567782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 N PRESIDENTIAL BOULEVARD",
            "address_2": "SUITE 301",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "19004",
            "telephone_number": "610-667-6161",
            "fax_number": "610-617-9275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 PRESIDENTIAL BLVD",
            "address_2": "SUITE 301",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041006",
            "telephone_number": "610-667-6161",
            "fax_number": "610-617-9275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALA INSTITUTE OF ORAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2022-03-04",
        "certification_date": "2022-03-04",
        "status": "A",
        "authorized_official_last_name": "WAXMAN",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "484-680-6405"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS023126L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "172847",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1610569",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "3776353",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "MA172847",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "1610569",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bala ASC
• Bala Better Health, LLC
• Bala Child and Family Association
• Bala Cynwyd Surgery Center
• Bala Dental Care, LLC
• Bala Kids Dentistry
• Bala Medical Associates P.C.
• Bala Medical, Inc
• Bala Orthodontics, LLC
• Bala Podiatry Associates

• Oral and Maxillofacial Surgery (Dentist) in Bala Cynwyd, PA
• Providers in Bala Cynwyd, PA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2022; 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.