Healthcare Provider Details

I. General information

NPI: 1356204036
Provider Name (Legal Business Name): KEYSTONE ORAL SURGERY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
LEWISBURG PA
17837-9350
US

IV. Provider business mailing address

30 BALDWIN BLVD STE 95
SHAMOKIN DAM PA
17876-9520
US

V. Phone/Fax

Practice location:
  • Phone: 570-884-8321
  • Fax: 570-256-1772
Mailing address:
  • Phone: 570-234-3555
  • Fax: 570-256-1772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. PRANATHI REDDY
Title or Position: OWNER
Credential: DDS
Phone: 267-809-2364