Provider Demographics
NPI:1639349715
Name:ANTHONY D KUPRIONAS DDS PC
Entity Type:Organization
Organization Name:ANTHONY D KUPRIONAS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KUPRIONAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-822-4140
Mailing Address - Street 1:24 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-2603
Mailing Address - Country:US
Mailing Address - Phone:570-822-4140
Mailing Address - Fax:570-822-0282
Practice Address - Street 1:24 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-2603
Practice Address - Country:US
Practice Address - Phone:570-822-4140
Practice Address - Fax:570-822-0282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015015470001OtherMEDICAL ASSISTANCE