Provider Demographics
NPI:1346309200
Name:TITUSVILLE DENTAL ARTS, P.C.
Entity Type:Organization
Organization Name:TITUSVILLE DENTAL ARTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:814-827-6714
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-0311
Mailing Address - Country:US
Mailing Address - Phone:814-827-6714
Mailing Address - Fax:814-827-2706
Practice Address - Street 1:202 UNION ST
Practice Address - Street 2:RM 3
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1166
Practice Address - Country:US
Practice Address - Phone:814-827-6714
Practice Address - Fax:814-827-2706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty