Provider Demographics
NPI:1194750380
Name:ORAL SURGERY ASSOCIATES OF CENTRAL PENNSYLVANIA, PC
Entity type:Organization
Organization Name:ORAL SURGERY ASSOCIATES OF CENTRAL PENNSYLVANIA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-696-4831
Mailing Address - Street 1:901 S LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-3035
Mailing Address - Country:US
Mailing Address - Phone:814-944-2802
Mailing Address - Fax:
Practice Address - Street 1:901 S LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-3035
Practice Address - Country:US
Practice Address - Phone:814-944-2802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001596335Medicaid
PA000864238OtherHIGHMARK BCBS
PACD6867OtherMEDICARE RAILROAD
PA000864238OtherHIGHMARK BCBS