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General NPI Number Information
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NPI Number | 1700803145
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Entity Type | Organization
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Legal Business Name | MICHAEL P GRESS DDS PC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 1223 SCALP AVE
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City | JOHNSTOWN
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State | PA
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Zip | 15904-3150
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Country | US
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Telephone | 814-266-2190
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Fax | 814-266-2903
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Provider Business Mailing Address
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Address Line | 1223 SCALP AVE
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City | JOHNSTOWN
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State | PA
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Zip | 15904-3150
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Country | US
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Telephone | 814-266-2190
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Fax | 814-266-2903
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Authorized Official
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Title or Position | SURG ASST
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Name | MS. REBECCA J GLADIS
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Credential |
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Telephone | 814-266-2190
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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 | DS034161L
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License Number State | PA
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