Provider Demographics
NPI:1558798215
Name:BRADFORD COUNTY DENTAL INC.
Entity Type:Organization
Organization Name:BRADFORD COUNTY DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:570-265-2069
Mailing Address - Street 1:1 ELIZABETH ST
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-1629
Mailing Address - Country:US
Mailing Address - Phone:570-265-2069
Mailing Address - Fax:570-265-8941
Practice Address - Street 1:1 ELIZABETH ST
Practice Address - Street 2:SUITE # 6
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-1629
Practice Address - Country:US
Practice Address - Phone:570-265-2069
Practice Address - Fax:570-265-8941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental