=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356204036
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEYSTONE ORAL SURGERY ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2025
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HOSPITAL DR
-----------------------------------------------------
City | LEWISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17837-9350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-884-8321
-----------------------------------------------------
Fax | 570-256-1772
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 BALDWIN BLVD STE 95
-----------------------------------------------------
City | SHAMOKIN DAM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17876-9520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-234-3555
-----------------------------------------------------
Fax | 570-256-1772
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PRANATHI REDDY
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 267-809-2364
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------