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General NPI Number Information
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NPI Number | 1114980745
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Entity Type | Organization
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Legal Business Name | DENTAL SURGEONS & ASSOCIATES,INC.
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | 419 N CHESTNUT ST
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City | SCOTTDALE
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State | PA
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Zip | 15683-1001
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Country | US
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Telephone | 724-887-6260
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Fax | 724-887-6801
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Provider Business Mailing Address
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Address Line | PO BOX 541
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City | SCOTTDALE
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State | PA
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Zip | 15683-0541
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Country | US
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Telephone | 724-887-6260
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Fax | 724-887-6801
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS EDWARD GRETZ SR.
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Credential | DDS
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Telephone | 724-887-6260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DSO16167L
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License Number State | PA
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