Provider Demographics
NPI:1922043322
Name:VALLEY ORAL SURGEON, LTD.
Entity Type:Organization
Organization Name:VALLEY ORAL SURGEON, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DELROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:814-536-4675
Mailing Address - Street 1:20 OSBORNE ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4128
Mailing Address - Country:US
Mailing Address - Phone:814-536-4675
Mailing Address - Fax:814-536-8897
Practice Address - Street 1:20 OSBORNE ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4128
Practice Address - Country:US
Practice Address - Phone:814-536-4675
Practice Address - Fax:814-536-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028079L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102928OtherUPMC PIN
PAVA112926OtherHIGHMARK GROUP PRACTICE
PAVA112926Medicare PIN