Provider Demographics
NPI:1720157084
Name:MOSHANNON VALLEY FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MOSHANNON VALLEY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-378-7479
Mailing Address - Street 1:439 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:HOUTZDALE
Mailing Address - State:PA
Mailing Address - Zip Code:16651-1702
Mailing Address - Country:US
Mailing Address - Phone:814-378-7479
Mailing Address - Fax:814-378-7439
Practice Address - Street 1:439 SPRING ST
Practice Address - Street 2:
Practice Address - City:HOUTZDALE
Practice Address - State:PA
Practice Address - Zip Code:16651-1702
Practice Address - Country:US
Practice Address - Phone:814-378-7479
Practice Address - Fax:814-378-7439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029496L1223G0001X
PADS031452L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA927201OtherUNITED CONCORDIA
PA0015366400003Medicaid
PA1015127030001Medicaid
PA0018194120002Medicaid