Provider Demographics
NPI:1083701726
Name:NORTHERN CAMBRIA DENTISTS
Entity Type:Organization
Organization Name:NORTHERN CAMBRIA DENTISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:LOVETTE
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:814-344-6644
Mailing Address - Street 1:2056 PLANK ROAD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15722-0598
Mailing Address - Country:US
Mailing Address - Phone:814-344-6644
Mailing Address - Fax:814-344-6332
Practice Address - Street 1:2056 PLANK ROAD
Practice Address - Street 2:
Practice Address - City:CARROLLTOWN
Practice Address - State:PA
Practice Address - Zip Code:15722-0598
Practice Address - Country:US
Practice Address - Phone:814-344-6644
Practice Address - Fax:814-344-6332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019482L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011543060001Medicaid
559332OtherUNITED CONCORDIA