Provider Demographics
NPI:1760449425
Name:ALLEN ORAL SURGERY ASSOCIATES P.C.
Entity Type:Organization
Organization Name:ALLEN ORAL SURGERY ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:PRUSACK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-821-8021
Mailing Address - Street 1:1251 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6205
Mailing Address - Country:US
Mailing Address - Phone:610-821-7021
Mailing Address - Fax:610-821-9551
Practice Address - Street 1:1251 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-821-7021
Practice Address - Fax:610-821-9551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS18393L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02355100OtherCAPITOL BLUE CROSS
PA2808OtherDORAL DENTAL USA
PA00520664Medicaid
PA184132OtherBLUE SHIELD
PA2688OtherDENTAL BENEFIT PROVIDERS
PA00520664Medicaid