Provider Demographics
NPI:1497102420
Name:DAVID G ALCORN, DMD, PC
Entity Type:Organization
Organization Name:DAVID G ALCORN, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:ALCORN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-443-6060
Mailing Address - Street 1:266 W PATRIOT ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-1565
Mailing Address - Country:US
Mailing Address - Phone:814-443-6060
Mailing Address - Fax:814-443-6050
Practice Address - Street 1:266 W PATRIOT ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1565
Practice Address - Country:US
Practice Address - Phone:814-443-6060
Practice Address - Fax:814-443-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027048L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty