Provider Demographics
NPI:1861585861
Name:LITITZ ORAL SURGERY
Entity type:Organization
Organization Name:LITITZ ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SIOBHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-627-2299
Mailing Address - Street 1:1575 HIGHLANDS DR STE 106
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7507
Mailing Address - Country:US
Mailing Address - Phone:717-627-2299
Mailing Address - Fax:717-627-4330
Practice Address - Street 1:1575 HIGHLANDS DR STE 106
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7507
Practice Address - Country:US
Practice Address - Phone:717-627-2299
Practice Address - Fax:717-627-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028494L1223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA090166Medicare PIN