Provider Demographics
NPI:1275617516
Name:DENTAL HEALTH CARE CENTRE PC
Entity Type:Organization
Organization Name:DENTAL HEALTH CARE CENTRE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:G
Authorized Official - Last Name:BEREZNAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-836-2808
Mailing Address - Street 1:920 SR 6W
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657
Mailing Address - Country:US
Mailing Address - Phone:570-836-2808
Mailing Address - Fax:570-836-6180
Practice Address - Street 1:920 STATE ROUTE 6 WEST
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657
Practice Address - Country:US
Practice Address - Phone:570-836-2808
Practice Address - Fax:570-836-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029539L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016874580003Medicaid