Provider Demographics
NPI:1639292360
Name:TACELOSKY, MARIA J (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:J
Last Name:TACELOSKY
Suffix:
Gender:F
Credentials:DMD
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Mailing Address - Street 1:107 S MARKET ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-4824
Mailing Address - Country:US
Mailing Address - Phone:570-752-8753
Mailing Address - Fax:570-759-6372
Practice Address - Street 1:107 S MARKET ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-4824
Practice Address - Country:US
Practice Address - Phone:570-752-8753
Practice Address - Fax:570-759-6372
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2013-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PADS028716L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice