Provider Demographics
NPI:1285882597
Name:ALTOONA CENTER FOR ORAL AND MAXILLOFACIAL SURGERY, LLC
Entity type:Organization
Organization Name:ALTOONA CENTER FOR ORAL AND MAXILLOFACIAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:SAWICKI
Authorized Official - Last Name:LAMPARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:814-946-5060
Mailing Address - Street 1:901 VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-6363
Mailing Address - Country:US
Mailing Address - Phone:814-946-5060
Mailing Address - Fax:814-946-4898
Practice Address - Street 1:901 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6363
Practice Address - Country:US
Practice Address - Phone:814-946-5060
Practice Address - Fax:814-946-4898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031238R261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018753130005Medicaid
PA0018753130005Medicaid
PAU63414Medicare UPIN