Provider Demographics
NPI:1538287537
Name:DENTAL HEALTH CLINIC
Entity Type:Organization
Organization Name:DENTAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PREETI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHASI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-752-8753
Mailing Address - Street 1:107 SOUTH MARKET STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603
Mailing Address - Country:US
Mailing Address - Phone:570-752-8753
Mailing Address - Fax:570-759-6372
Practice Address - Street 1:107 SOUTH MARKET STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603
Practice Address - Country:US
Practice Address - Phone:570-752-8753
Practice Address - Fax:570-759-6372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018712160002Medicaid
155553OtherUNISON UNITED HEALTHCARE