Provider Demographics
NPI:1770557118
Name:CALLAHAN AND BERGEY ASSOCIATES P.C.
Entity type:Organization
Organization Name:CALLAHAN AND BERGEY ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-288-9070
Mailing Address - Street 1:550 3RD AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5806
Mailing Address - Country:US
Mailing Address - Phone:570-288-9070
Mailing Address - Fax:570-288-4201
Practice Address - Street 1:550 3RD AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5806
Practice Address - Country:US
Practice Address - Phone:570-288-9070
Practice Address - Fax:570-288-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA553121OtherBLUE SHIELD MEDICAL/DENTA