Provider Demographics
NPI:1972602621
Name:LOFTUS-MERMER ORAL SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:LOFTUS-MERMER ORAL SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:MERMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-281-3400
Mailing Address - Street 1:10101 ACADEMY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1120
Mailing Address - Country:US
Mailing Address - Phone:215-281-3400
Mailing Address - Fax:215-281-3477
Practice Address - Street 1:10101 ACADEMY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1120
Practice Address - Country:US
Practice Address - Phone:215-281-3400
Practice Address - Fax:215-281-3477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA175253OtherBLUE SHIELD
PA175253OtherPERSONAL CHOICE
PA0060890000OtherKEYSTONE
PA17411OtherAETNA