Provider Demographics
NPI:1720479637
Name:TIMOTHY MARK OPIEL DENTISTRY LLC
Entity Type:Organization
Organization Name:TIMOTHY MARK OPIEL DENTISTRY LLC
Other - Org Name:PITTSTON DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:OPIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-654-2484
Mailing Address - Street 1:34 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-1827
Mailing Address - Country:US
Mailing Address - Phone:570-654-2484
Mailing Address - Fax:570-654-4867
Practice Address - Street 1:34 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-1827
Practice Address - Country:US
Practice Address - Phone:570-654-2484
Practice Address - Fax:570-654-4867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025160190002Medicaid