Provider Demographics
NPI:1073777116
Name:CENTRAL PENNSYLVANIA ENDODONTICS, LLC
Entity Type:Organization
Organization Name:CENTRAL PENNSYLVANIA ENDODONTICS, LLC
Other - Org Name:ROBERT G SAYLOR, D.D.S., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:SAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:814-238-4400
Mailing Address - Street 1:240 S BURROWES ST
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4008
Mailing Address - Country:US
Mailing Address - Phone:814-238-4400
Mailing Address - Fax:
Practice Address - Street 1:240 S BURROWES ST
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4008
Practice Address - Country:US
Practice Address - Phone:814-238-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0291511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA674228OtherUNITED CONCORDIA