Provider Demographics
NPI:1043240013
Name:VALLEY ORAL SURGERY PC
Entity Type:Organization
Organization Name:VALLEY ORAL SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LASKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-437-1727
Mailing Address - Street 1:1321 W NEW ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018
Mailing Address - Country:US
Mailing Address - Phone:610-861-7406
Mailing Address - Fax:610-974-8966
Practice Address - Street 1:1275 S CEDAR CREST BLVD STE 1
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6242
Practice Address - Country:US
Practice Address - Phone:610-437-1727
Practice Address - Fax:610-437-4715
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY ORAL SURGERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-04
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1039082Medicaid
PA1039082Medicaid