Provider Demographics
NPI:1104466028
Name:KEYSTONE ORAL AND MAXILLOFACIAL SURGERY, P.C.
Entity type:Organization
Organization Name:KEYSTONE ORAL AND MAXILLOFACIAL SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:878-295-8322
Mailing Address - Street 1:560 RUGH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5601
Mailing Address - Country:US
Mailing Address - Phone:878-295-8322
Mailing Address - Fax:878-295-8323
Practice Address - Street 1:560 RUGH ST STE 100
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5601
Practice Address - Country:US
Practice Address - Phone:878-295-8322
Practice Address - Fax:878-295-8323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty