Provider Demographics
NPI:1457474454
Name:GERMANOSKI FAMILY DENTISTRY
Entity Type:Organization
Organization Name:GERMANOSKI FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GERMANOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-763-4811
Mailing Address - Street 1:435 MAIN STREET
Mailing Address - Street 2:PO BOX 868
Mailing Address - City:SAEGERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:16433
Mailing Address - Country:US
Mailing Address - Phone:814-763-4811
Mailing Address - Fax:814-763-2771
Practice Address - Street 1:435 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SAEGERTOWN
Practice Address - State:PA
Practice Address - Zip Code:16433
Practice Address - Country:US
Practice Address - Phone:814-763-4811
Practice Address - Fax:814-763-2771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0351231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty