Provider Demographics
NPI:1114980745
Name:DENTAL SURGEONS & ASSOCIATES,INC.
Entity Type:Organization
Organization Name:DENTAL SURGEONS & ASSOCIATES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GRETZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:724-887-6260
Mailing Address - Street 1:PO BOX 541
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-0541
Mailing Address - Country:US
Mailing Address - Phone:724-887-6260
Mailing Address - Fax:724-887-6801
Practice Address - Street 1:419 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-1001
Practice Address - Country:US
Practice Address - Phone:724-887-6260
Practice Address - Fax:724-887-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO16167L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA006431OtherDORAL DENTAL
PA32240OtherDENTAL BENEFIT
PA446180OtherUNITED CONCORDIA
PA0017959470001Medicaid
PA122004OtherMED PLUS