NPIMap

Organization Active NPI

Innovative Implant & Oral Surgery PC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Feasterville Trevose, PA
National Provider Identifier
1679547707
Registry record updated Jan 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
Legal business name
INNOVATIVE IMPLANT & ORAL SURGERY PC
Practice address
1300 Bridgetown Pike
Feasterville Trevose, PA 19053-4326
Phone
(215) 322-7810
Fax
(215) 322-7832
NPI assigned
Feb 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2026

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

Authorized official

Name
Ms. Debra Robyn Lodise
Title
Office Manager
Phone
(215) 322-7810

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193400000X SINGLE SPECIALTY GROUP 204E00000X Primary
Customized Equipment (DME) 332BC3200X

Addresses

Primary practice location

1300 Bridgetown Pike
Feasterville Trevose, PA 19053-4326

Mailing address

1300 Bridgetown Pike
Feasterville Trevose, PA 19053-4326
Phone (215) 322-7810

Other practice location 1

638 Newtown Yardley Rd Ste 2A
Newtown, PA 18940-1739
Phone (215) 322-7810

Other practice location 2

1494 Old York Rd Fl 2
Abington, PA 19001-2614
Phone (215) 322-7810

Other identifiers 5

IdentifierTypeStateIssuer
1615888OtherPASALIN BLUE SHIELD
0547613000OtherPAKEYST GROUP#
4437OtherPAAETNA NISSMAN
161558OtherPANISSMAN BLUE SHIELD
747908OtherPABLUE SHIELD GROUP#

Other names 2

  • Charles B Nissman DDS Former legal business name
  • Nissman-Salin Oral & Maxillofacial Surgery PC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070816000828 PA Part B Supplier - Clinic/Group Practice 3375635642 Receives reassigned benefits from 7 practitioners
Practice locations: Abington, PA; Feasterville, PA; Jenkintown, PA; Newtown, PA

National Provider Directory

National Provider Directory

Locations

1494 Old York Rd
Fl 2
Abington, PA 19001
Phone (215) 322-7810

1300 Bridgetown Pike
Fstrvl Trvose, PA 19053
Phone (215) 322-7810

638 Newtown Yardley Rd
Ste 2A
Newtown, PA 18940
Phone (215) 322-7810

137 W Street Rd
Trevose, PA 19053
Phone (215) 322-7810

Practitioners & affiliated clinicians

Practitioners 8

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": "1139961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769126400000",
    "number": "1679547707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 BRIDGETOWN PIKE",
            "city": "FEASTERVILLE TREVOSE",
            "state": "PA",
            "postal_code": "190534326",
            "telephone_number": "215-322-7810",
            "fax_number": "215-322-7832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 BRIDGETOWN PIKE",
            "city": "FEASTERVILLE TREVOSE",
            "state": "PA",
            "postal_code": "190534326",
            "telephone_number": "215-322-7810",
            "fax_number": "215-322-7832"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "638 Newtown Yardley Rd Ste 2A",
            "address_purpose": "LOCATION",
            "city": "Newtown",
            "state": "PA",
            "postal_code": "189401739",
            "country_code": "US",
            "telephone_number": "215-322-7810",
            "fax_number": "215-322-7832",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1494 Old York Rd Fl 2",
            "address_purpose": "LOCATION",
            "city": "Abington",
            "state": "PA",
            "postal_code": "190012614",
            "country_code": "US",
            "telephone_number": "215-322-7810",
            "fax_number": "215-322-7832",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INNOVATIVE IMPLANT & ORAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-15",
        "last_updated": "2026-01-23",
        "certification_date": "2026-01-23",
        "status": "A",
        "authorized_official_last_name": "LODISE",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "ROBYN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "215-322-7810",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SALIN BLUE SHIELD",
            "identifier": "1615888",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYST GROUP#",
            "identifier": "0547613000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA NISSMAN",
            "identifier": "4437",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NISSMAN BLUE SHIELD",
            "identifier": "161558",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP#",
            "identifier": "747908",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charles B Nissman DDS",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Charles B Nissman DDS",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Nissman-Salin Oral & Maxillofacial Surgery PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Feasterville Trevose, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2026; 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.