Organization
ALLEN ORAL SURGERY ASSOCIATES P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS O. PRUSACK D.D.S. (PRESIDENT)
(610) 821-8021
Entity
Organization
Contact information
Practice address
1251 S CEDAR CREST BLVD, SUITE 310, ALLENTOWN, PA 18103-6205
(610) 821-7021
(610) 821-9551
Mailing address
1251 S CEDAR CREST BLVD, SUITE 310, ALLENTOWN, PA 18103-6205
(610) 821-7021
(610) 821-9551
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS18393L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00520664
—
PA
01
—
02355100
CAPITOL BLUE CROSS
PA
01
—
184132
BLUE SHIELD
PA
01
—
2688
DENTAL BENEFIT PROVIDERS
PA
01
—
2808
DORAL DENTAL USA
PA
Enumeration date
04/27/2006
Last updated
08/22/2020
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