Provider Demographics
NPI:1639278468
Name:TWIST, JOHN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:TWIST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3277 SOUTH PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218
Mailing Address - Country:US
Mailing Address - Phone:716-825-6766
Mailing Address - Fax:716-825-6766
Practice Address - Street 1:3277 SOUTH PARK AVE
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218
Practice Address - Country:US
Practice Address - Phone:716-825-6766
Practice Address - Fax:716-825-6766
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice