Provider Demographics
NPI:1598791741
Name:PROBST, DENNIS SCOTT (D O)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:SCOTT
Last Name:PROBST
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 OUTLET LN
Practice Address - Street 2:SUITE 400
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-7815
Practice Address - Country:US
Practice Address - Phone:570-769-1300
Practice Address - Fax:570-769-1301
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010065L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102533332-0004Medicaid
PA800592YRFNMedicare UPIN