Provider Demographics
NPI:1225253388
Name:CENTURY DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:CENTURY DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KRENITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-876-4488
Mailing Address - Street 1:696 SCRANTON CARBONDALE HWY
Mailing Address - Street 2:
Mailing Address - City:EYNON
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1004
Mailing Address - Country:US
Mailing Address - Phone:570-876-4488
Mailing Address - Fax:570-876-1625
Practice Address - Street 1:696 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:EYNON
Practice Address - State:PA
Practice Address - Zip Code:18403-1004
Practice Address - Country:US
Practice Address - Phone:570-876-4488
Practice Address - Fax:570-876-1625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS241161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1669549325OtherDENTIST
PA1083781751OtherDENTIST