Provider Demographics
NPI:1578966180
Name:CHILDRENS GENERAL DENTISTRY PC
Entity Type:Organization
Organization Name:CHILDRENS GENERAL DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:VERMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-645-2044
Mailing Address - Street 1:39 W LUDLOW ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SUMMIT HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18250-1141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39 W LUDLOW ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SUMMIT HILL
Practice Address - State:PA
Practice Address - Zip Code:18250-1141
Practice Address - Country:US
Practice Address - Phone:570-645-2044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-28
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental