Provider Demographics
NPI:1356071161
Name:THOMAS J DONAHUE
Entity Type:Organization
Organization Name:THOMAS J DONAHUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PUSKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-674-7474
Mailing Address - Street 1:40 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1804
Mailing Address - Country:US
Mailing Address - Phone:570-674-7474
Mailing Address - Fax:570-674-2984
Practice Address - Street 1:40 MAIN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1804
Practice Address - Country:US
Practice Address - Phone:570-674-7474
Practice Address - Fax:570-674-2984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty