Organization
CENTRE ORAL & FACIAL SURGERY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY F KEWITT DMD, MD (OWNER/PRESIDENT)
(814) 235-7700
Entity
Organization
Contact information
Practice address
474 WINDMERE DR, SUITE 202, STATE COLLEGE, PA 16801-7668
(814) 235-7700
(814) 235-7633
Mailing address
474 WINDMERE DR STE 202, STATE COLLEGE, PA 16801-7643
(814) 235-7700
(814) 235-7633
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS029616L
PA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
MD073230L
PA
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
MD073230L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KE1304618
HIGHMARK BLUE SHIELD
PA
Enumeration date
05/04/2006
Last updated
04/18/2024
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