Lebanon Oral Surgery Group PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

LEBANON ORAL SURGERY GROUP PLLC

Practice address

860 Tuck St Ste 100
Lebanon, PA 17042-7477

Phone

(717) 273-6745

NPI assigned

May 12, 2022

Organization subpart

No

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

Authorized official

Name

Alexandre Balaci, DMDNPI 1174514830

Title

Owner

Phone

(717) 273-6745

Specialties & licenses 1

Addresses

Other names 1

• Balaci Oral and Facial Surgery Former legal business name

Electronic endpoints 1

Locations

Practitioners 1

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

• Alexandre Balaci, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Lebanon, PA
  • NPI 1174514830

  Oral and Maxillofacial Surgery

  NPD Authorized official

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

{
    "created_epoch": "1652313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652313600000",
    "number": "1902542863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 TUCK ST STE 100",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427477",
            "telephone_number": "717-273-6745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 TUCK ST STE 100",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427477",
            "telephone_number": "717-273-6745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEBANON ORAL SURGERY GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-12",
        "last_updated": "2022-05-12",
        "certification_date": "2022-05-12",
        "status": "A",
        "authorized_official_last_name": "BALACI",
        "authorized_official_first_name": "ALEXANDRE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "717-273-6745",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "stacy@jawcare.com",
            "affiliation": "N",
            "address_1": "860 Tuck St Ste 100",
            "city": "Lebanon",
            "state": "PA",
            "country_code": "US",
            "postal_code": "170427477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Balaci Oral and Facial Surgery",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Oral and Maxillofacial Surgery (Dentist) in Lebanon, PA
• Providers in Lebanon, 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 May 12, 2022; 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.