MEDICARE: KEYSTONE ORAL SURGERY ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1275492720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE ORAL SURGERY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	30 BALDWIN BLVD STE 95
Second Line	:
City	:	SHAMOKIN DAM
State	:	PA
Zip	:	17876-9520
Country	:	US
Telephone Number	:	610-570-8321
Fax Number	:	570-256-1772

Provider Business Practice Location Address
First Line	:	1061 LINCOLN WAY E
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-2819
Country	:	US
Telephone Number	:	717-983-0627
Fax Number	:	717-983-2221

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	KAREN L FITZCHARLES
Credential	:
Telephone Number	:	570-884-8321

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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