Organization
IMPLANT DENTISTRY ASSOCIATES P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLIFFORD GRATZ (MANAGER)
(484) 231-1177
Entity
Organization
Contact information
Practice address
234 MALL BLVD, SUITE 180, KING OF PRUSSIA, PA 19406-2954
(484) 231-1177
(484) 231-8964
Mailing address
234 MALL BLVD, SUITE 180, KING OF PRUSSIA, PA 19406-2954
(484) 231-1177
(484) 231-8964
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
DS024390L
PA
1223P0700X
Prosthodontics
DS027440L
PA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS035811L
PA
Other
Enumeration date
12/13/2012
Last updated
12/17/2012
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