Provider Demographics
NPI:1093887978
Name:FELLOWS AND SMINK DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:FELLOWS AND SMINK DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:H
Authorized Official - Last Name:FELLOWS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-622-4080
Mailing Address - Street 1:2223 W END AVE
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-1825
Mailing Address - Country:US
Mailing Address - Phone:570-622-4080
Mailing Address - Fax:570-622-2720
Practice Address - Street 1:2223 W END AVE
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1825
Practice Address - Country:US
Practice Address - Phone:570-622-4080
Practice Address - Fax:570-622-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty