| NPI | 1093732000 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH ANTHONY ILACQUA President Owner 610-275-0500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS022706L) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS019424L) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2008-06-18 |