Provider Demographics
NPI:1780851519
Name:ACHILLE FAMILY DENTAL,INC
Entity type:Organization
Organization Name:ACHILLE FAMILY DENTAL,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTY
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:ACHILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-849-3300
Mailing Address - Street 1:389 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-1214
Mailing Address - Country:US
Mailing Address - Phone:814-849-3300
Mailing Address - Fax:814-849-3309
Practice Address - Street 1:389 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-1214
Practice Address - Country:US
Practice Address - Phone:814-849-3300
Practice Address - Fax:814-849-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty