Provider Demographics
NPI:1811026065
Name:VALLEY ORAL & MAXILLOFACIAL SURGERY PC
Entity Type:Organization
Organization Name:VALLEY ORAL & MAXILLOFACIAL SURGERY PC
Other - Org Name:STAVISKY & GIALLORENZI PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:GIALLORENZI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-346-7301
Mailing Address - Street 1:401 ADAMS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2025
Mailing Address - Country:US
Mailing Address - Phone:570-346-7301
Mailing Address - Fax:570-346-7575
Practice Address - Street 1:401 ADAMS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2025
Practice Address - Country:US
Practice Address - Phone:570-346-7301
Practice Address - Fax:570-346-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017472L1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU97366Medicare UPIN
PAT29808Medicare UPIN
PAU86857Medicare UPIN