Provider Demographics
NPI:1225213242
Name:FAMILY PROSTHETIC & DENTAL IMPLANT ASSOCIATES OF WYOMING COUNTY, P.C.
Entity Type:Organization
Organization Name:FAMILY PROSTHETIC & DENTAL IMPLANT ASSOCIATES OF WYOMING COUNTY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-836-8942
Mailing Address - Street 1:161 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-1127
Mailing Address - Country:US
Mailing Address - Phone:570-836-8942
Mailing Address - Fax:570-836-9712
Practice Address - Street 1:161 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-1127
Practice Address - Country:US
Practice Address - Phone:570-836-8942
Practice Address - Fax:570-836-9712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027490L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty