Provider Demographics
NPI:1235281445
Name:GRETZ, THOMAS EDWARD JR (DMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:GRETZ
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1001
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
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO31193L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA006431OtherDORAL DENTAL
PA122004OtherMED PLUS
PA0017959650001Medicaid
PA32240OtherDENTAL BENEFIT
PA446180OtherUNITED CONCORDIA