Provider Demographics
NPI:1134347933
Name:SELINSGROVE DENTAL ARTS
Entity type:Organization
Organization Name:SELINSGROVE DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ENDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-374-4655
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-0265
Mailing Address - Country:US
Mailing Address - Phone:570-374-4625
Mailing Address - Fax:570-374-0041
Practice Address - Street 1:504 W PENN ST
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-1644
Practice Address - Country:US
Practice Address - Phone:570-374-4625
Practice Address - Fax:570-374-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA28131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty