1508497587 NPI number — EAGLES ORAL SURGERY

Table of content: DR. THOMAS DAVID MAZER M.D. (NPI 1659600088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508497587 NPI number — EAGLES ORAL SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAGLES ORAL SURGERY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508497587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 PENN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYOMISSING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19610-2140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-773-1717
Provider Business Mailing Address Fax Number:
484-773-1717

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 KENHORST PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19607-3648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-773-1717
Provider Business Practice Location Address Fax Number:
484-773-1717
Provider Enumeration Date:
01/29/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHANK
Authorized Official First Name:
MEGAN
Authorized Official Middle Name:
Authorized Official Title or Position:
QUALITY CONTROL MANAGER
Authorized Official Telephone Number:
610-372-6313

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)