Provider Demographics
NPI:1265479638
Name:TRI-COUNTY ORAL-FACIAL SURGEONS, PC
Entity type:Organization
Organization Name:TRI-COUNTY ORAL-FACIAL SURGEONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ENGROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD DDS
Authorized Official - Phone:814-238-0587
Mailing Address - Street 1:200 W BEAVER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801
Mailing Address - Country:US
Mailing Address - Phone:814-238-0587
Mailing Address - Fax:814-238-3840
Practice Address - Street 1:200 W BEAVER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-238-0587
Practice Address - Fax:814-238-3840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
50000663OtherCAPITAL BLUE CROSS
118029OtherHIGHMARK
1226OtherGEISINGER HEALTH PLAN
1226OtherGEISINGER HEALTH PLAN