Provider Demographics
NPI:1316227283
Name:DENTAL ARTS PC
Entity Type:Organization
Organization Name:DENTAL ARTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:REICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-283-0554
Mailing Address - Street 1:386 NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5448
Mailing Address - Country:US
Mailing Address - Phone:570-283-0554
Mailing Address - Fax:570-283-0555
Practice Address - Street 1:386 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-5448
Practice Address - Country:US
Practice Address - Phone:570-283-0554
Practice Address - Fax:570-283-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAO19968L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005285460001Medicaid