Greater Philadelphia Oms LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

GREATER PHILADELPHIA OMS LLC

Practice address

401 Township Line Rd Ste C
Elkins Park, PA 19027-2277

Phone

(215) 379-3382

NPI assigned

Aug 3, 2026

Organization subpart

No

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

Authorized official

Name

Chad Hendricks

Title

Cedentialing

Phone

(612) 859-0444

Specialties & licenses 1

Addresses

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
  NPD (past)
• Robert David Mogyoros, DMD

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

  • Oral and Maxillofacial Surgery (Dentist)
  • Newton, MA
  • NPI 1194141200
  NPD (past)
• 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": "1785715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785715200000",
    "number": "1699698936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 TOWNSHIP LINE RD STE C",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190272277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 TOWNSHIP LINE RD STE C",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190272277",
            "telephone_number": "215-379-3382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER PHILADELPHIA OMS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-08-03",
        "last_updated": "2026-08-03",
        "certification_date": "2026-08-03",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "CEDENTIALING",
        "authorized_official_telephone_number": "612-859-0444"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• Oral and Maxillofacial Surgery (Dentist) in Elkins Park, PA
• Providers in Elkins Park, 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 Aug 3, 2026; 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.