Healthcare Provider Details

I. General information

NPI: 1114980745
Provider Name (Legal Business Name): DENTAL SURGEONS & ASSOCIATES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 N CHESTNUT ST
SCOTTDALE PA
15683-1001
US

IV. Provider business mailing address

PO BOX 541
SCOTTDALE PA
15683-0541
US

V. Phone/Fax

Practice location:
  • Phone: 724-887-6260
  • Fax: 724-887-6801
Mailing address:
  • Phone: 724-887-6260
  • Fax: 724-887-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDSO16167L
License Number StatePA

VIII. Authorized Official

Name: DR. THOMAS EDWARD GRETZ SR.
Title or Position: PRESIDENT
Credential: DDS
Phone: 724-887-6260