Provider Demographics
NPI:1598231193
Name:DONEGAL DENTAL CENTER PC
Entity Type:Organization
Organization Name:DONEGAL DENTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:NISTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-951-1821
Mailing Address - Street 1:3846 ROUTE 31 STE 5
Mailing Address - Street 2:
Mailing Address - City:DONEGAL
Mailing Address - State:PA
Mailing Address - Zip Code:15628-4033
Mailing Address - Country:US
Mailing Address - Phone:724-593-5555
Mailing Address - Fax:724-593-5554
Practice Address - Street 1:3846 ROUTE 31 STE 5
Practice Address - Street 2:
Practice Address - City:DONEGAL
Practice Address - State:PA
Practice Address - Zip Code:15628-4033
Practice Address - Country:US
Practice Address - Phone:724-593-5555
Practice Address - Fax:724-593-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty