Provider Demographics
NPI:1508453036
Name:COOPERSBURG DENTAL PLLC
Entity Type:Organization
Organization Name:COOPERSBURG DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-655-7645
Mailing Address - Street 1:457 N MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-2185
Mailing Address - Country:US
Mailing Address - Phone:570-655-7645
Mailing Address - Fax:570-299-7427
Practice Address - Street 1:20 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-1911
Practice Address - Country:US
Practice Address - Phone:610-282-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental