Provider Demographics
NPI:1023672771
Name:CENTURY DENTAL MP
Entity type:Organization
Organization Name:CENTURY DENTAL MP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-839-2101
Mailing Address - Street 1:33 STERLING RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT POCONO
Mailing Address - State:PA
Mailing Address - Zip Code:18344-1118
Mailing Address - Country:US
Mailing Address - Phone:570-839-2101
Mailing Address - Fax:570-839-2105
Practice Address - Street 1:33 STERLING RD
Practice Address - Street 2:
Practice Address - City:MOUNT POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344-1118
Practice Address - Country:US
Practice Address - Phone:570-839-2101
Practice Address - Fax:570-839-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1205196227OtherDR WILLIAM DEMPSEY
PA1083781751OtherDR JASON HANYON
PA1992816284OtherDR JAMES SIROTNAK