Provider Demographics
NPI:1407216526
Name:DENTAL SPECIALISTS OF NEPA
Entity Type:Organization
Organization Name:DENTAL SPECIALISTS OF NEPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-331-0824
Mailing Address - Street 1:500 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5810
Mailing Address - Country:US
Mailing Address - Phone:570-331-0824
Mailing Address - Fax:570-331-0827
Practice Address - Street 1:500 3RD AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5810
Practice Address - Country:US
Practice Address - Phone:570-331-0824
Practice Address - Fax:570-331-0827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017029L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty