Provider Demographics
NPI:1356677868
Name:SUSQUEHANNA RIVER VALLEY DENTAL HEALTH CLINIC
Entity Type:Organization
Organization Name:SUSQUEHANNA RIVER VALLEY DENTAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN BOARD OF DIRECTORS
Authorized Official - Prefix:DR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-524-2729
Mailing Address - Street 1:335 MARKET ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-3411
Mailing Address - Country:US
Mailing Address - Phone:570-286-7500
Mailing Address - Fax:570-286-1524
Practice Address - Street 1:335 MARKET ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-3411
Practice Address - Country:US
Practice Address - Phone:570-286-7500
Practice Address - Fax:570-286-1524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty