Provider Demographics
NPI:1518670165
Name:KEYSTONE ORAL SURGERY ASSOCIATES PC
Entity Type:Organization
Organization Name:KEYSTONE ORAL SURGERY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRANATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-884-8321
Mailing Address - Street 1:78 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502-5851
Mailing Address - Country:US
Mailing Address - Phone:267-809-2364
Mailing Address - Fax:
Practice Address - Street 1:30 BALDWIN BLVD STE 95
Practice Address - Street 2:
Practice Address - City:SHAMOKIN DAM
Practice Address - State:PA
Practice Address - Zip Code:17876-9520
Practice Address - Country:US
Practice Address - Phone:570-884-8321
Practice Address - Fax:570-256-1772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty