Provider Demographics
NPI:1255585873
Name:ABSOLUTE ORAL SURGERY & IMPLANT CENTERS PC
Entity type:Organization
Organization Name:ABSOLUTE ORAL SURGERY & IMPLANT CENTERS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRETZULA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-513-7172
Mailing Address - Street 1:456 SCHOOL LN
Mailing Address - Street 2:103
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-1715
Mailing Address - Country:US
Mailing Address - Phone:215-513-7172
Mailing Address - Fax:215-513-7192
Practice Address - Street 1:456 SCHOOL LN
Practice Address - Street 2:103
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-1715
Practice Address - Country:US
Practice Address - Phone:215-513-7172
Practice Address - Fax:215-513-7192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORAL SURGERY & IMPLANT CENTERS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 0358491223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty