Provider Demographics
NPI:1295220648
Name:DENTAL ASSOCIATES OF NEPA PC
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF NEPA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS PAYABLE
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-822-4065
Mailing Address - Street 1:360 KIDDER ST STE 5
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-5619
Mailing Address - Country:US
Mailing Address - Phone:570-822-4065
Mailing Address - Fax:570-820-9836
Practice Address - Street 1:360 KIDDER STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-822-4065
Practice Address - Fax:570-820-9836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028210L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty