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General NPI Number Information
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NPI Number | 1518670165
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Entity Type | Organization
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Legal Business Name | KEYSTONE ORAL SURGERY ASSOCIATES PC
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Dates
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Enumeration Date | 12/28/2022
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Last Update Date | 02/05/2023
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Provider Practice Location Address
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Address Line | 30 BALDWIN BLVD STE 95
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City | SHAMOKIN DAM
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State | PA
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Zip | 17876-9520
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Country | US
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Telephone | 570-884-8321
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Fax | 570-256-1772
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Provider Business Mailing Address
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Address Line | 78 WINDSOR RD
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City | BELLE MEAD
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State | NJ
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Zip | 08502-5851
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Country | US
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Telephone | 267-809-2364
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PRANATHI REDDY
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Credential | DDS
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Telephone | 570-884-8321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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