Maxillofacial Surgical Associates, P.C.

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

Legal business name

MAXILLOFACIAL SURGICAL ASSOCIATES, P.C.

Practice address

1601 Walnut St
Suite 1116
Philadelphia, PA 19102-2944

Phone

(215) 640-0811

Fax

(215) 640-0912

NPI assigned

Feb 21, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Allan S. Shaw, D.D.S.NPI 1871525485

Title

President

Phone

(215) 640-0811

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Practitioners 1

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

• Allan S. Shaw, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Philadelphia, PA
  • NPI 1871525485
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1329782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329782400000",
    "number": "1942573902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 WALNUT ST",
            "address_2": "SUITE 1116",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191022944",
            "telephone_number": "215-640-0811",
            "fax_number": "215-640-0912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 WALNUT ST",
            "address_2": "SUITE 1116",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191022944",
            "telephone_number": "215-640-0811",
            "fax_number": "215-640-0912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAXILLOFACIAL SURGICAL ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-21",
        "last_updated": "2012-02-21",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "ALLAN",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-640-0811",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral & Maxillofacial Surgery (D.M.D.) in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2012; 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.