Provider Demographics
NPI:1629284914
Name:NAHAS AND DONAHUE ORTHODONTICS
Entity Type:Organization
Organization Name:NAHAS AND DONAHUE ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ACCOUNT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PUSKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-823-2162
Mailing Address - Street 1:34 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-1723
Mailing Address - Country:US
Mailing Address - Phone:570-823-2162
Mailing Address - Fax:
Practice Address - Street 1:34 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-1723
Practice Address - Country:US
Practice Address - Phone:570-823-2162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0194341223X0400X
PADS029019L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty