Implant Dentistry Associates P.C.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DS035811L Issued in PA

Legal business name

IMPLANT DENTISTRY ASSOCIATES P.C.

Practice address

234 Mall Blvd
Suite 180
King of Prussia, PA 19406-2954

Phone

(484) 231-1177

Fax

(484) 231-8964

NPI assigned

Dec 13, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Clifford Gratz

Title

Manager

Phone

(484) 231-1177

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355702400000",
    "number": "1417293739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 MALL BLVD",
            "address_2": "SUITE 180",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194062954",
            "telephone_number": "484-231-1177",
            "fax_number": "484-231-8964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 MALL BLVD",
            "address_2": "SUITE 180",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194062954",
            "telephone_number": "484-231-1177",
            "fax_number": "484-231-8964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPLANT DENTISTRY ASSOCIATES P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-13",
        "last_updated": "2012-12-17",
        "status": "A",
        "authorized_official_last_name": "GRATZ",
        "authorized_official_first_name": "CLIFFORD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "484-231-1177",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "PA",
            "license": "DS024390L",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "PA",
            "license": "DS027440L",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS035811L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in King of Prussia, PA
• Providers in King of Prussia, PA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.