Provider Demographics
NPI:1700297991
Name:OXFORD DENTAL ASSOCIATES
Entity type:Organization
Organization Name:OXFORD DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:PATELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:610-932-3388
Mailing Address - Street 1:102 CONNER RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363-1292
Mailing Address - Country:US
Mailing Address - Phone:610-932-3388
Mailing Address - Fax:
Practice Address - Street 1:102 CONNER RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-1292
Practice Address - Country:US
Practice Address - Phone:610-932-3388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETER P. PATELLIS, DMD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-10
Last Update Date:2014-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty