Provider Demographics
NPI:1285856823
Name:JACK AUGHENBAUGH DDS, PC
Entity Type:Organization
Organization Name:JACK AUGHENBAUGH DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:A
Authorized Official - Last Name:AUGHENBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-682-8143
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:HEGINS
Mailing Address - State:PA
Mailing Address - Zip Code:17938
Mailing Address - Country:US
Mailing Address - Phone:570-682-8143
Mailing Address - Fax:570-682-8630
Practice Address - Street 1:1144 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:HEGINS
Practice Address - State:PA
Practice Address - Zip Code:17938
Practice Address - Country:US
Practice Address - Phone:570-682-8143
Practice Address - Fax:570-682-8630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022224-L261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical