Provider Demographics
NPI:1669804662
Name:MOUNTAIN VIEW DENTAL
Entity type:Organization
Organization Name:MOUNTAIN VIEW DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-585-8888
Mailing Address - Street 1:239 NORTHERN BLVD
Mailing Address - Street 2:MOUNTAIN VIEW DENTAL
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9302
Mailing Address - Country:US
Mailing Address - Phone:570-585-8888
Mailing Address - Fax:570-585-8889
Practice Address - Street 1:239 NORTHERN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-9302
Practice Address - Country:US
Practice Address - Phone:570-585-8888
Practice Address - Fax:570-585-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030736L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017301920003Medicaid