Provider Demographics
NPI:1700803145
Name:MICHAEL P GRESS DDS PC
Entity Type:Organization
Organization Name:MICHAEL P GRESS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURG ASST
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLADIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-266-2190
Mailing Address - Street 1:1223 SCALP AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3150
Mailing Address - Country:US
Mailing Address - Phone:814-266-2190
Mailing Address - Fax:814-266-2903
Practice Address - Street 1:1223 SCALP AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3150
Practice Address - Country:US
Practice Address - Phone:814-266-2190
Practice Address - Fax:814-266-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS034161L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA615753OtherHIGHMARK PROVIDER ID
PA0018046340001Medicaid
PA615753OtherHIGHMARK PROVIDER ID