# IMPLANT DENTISTRY ASSOCIATES P.C.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417293739
- **Authorized official:** MR. CLIFFORD GRATZ (MANAGER)
- **Authorized official phone:** (484) 231-1177

## Contact information

- **Practice address:** 234 MALL BLVD, SUITE 180, KING OF PRUSSIA, PA 19406-2954
- **Practice address phone:** (484) 231-1177
- **Practice address fax:** (484) 231-8964
- **Mailing address:** 234 MALL BLVD, SUITE 180, KING OF PRUSSIA, PA 19406-2954
- **Mailing address phone:** (484) 231-1177
- **Mailing address fax:** (484) 231-8964

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0300X | Periodontics | DS024390L | PA | — |
| 1223P0700X | Prosthodontics | DS027440L | PA | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DS035811L | PA | Yes |

## Other

- **Enumeration date:** 12/13/2012
- **Last updated:** 12/17/2012