Provider Demographics
NPI:1235204488
Name:DR KATHY PERCOSKY'S GENTLE DENTISTRY
Entity Type:Organization
Organization Name:DR KATHY PERCOSKY'S GENTLE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PERCOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:814-535-6458
Mailing Address - Street 1:1501 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-8813
Mailing Address - Country:US
Mailing Address - Phone:814-262-7429
Mailing Address - Fax:
Practice Address - Street 1:203 STRAYER ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15906-2012
Practice Address - Country:US
Practice Address - Phone:814-535-6458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028979L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019507300001OtherMEDICAL ASSISTANCE
PA86013OtherUNITED CONCORDIA