Provider Demographics
NPI:1841055274
Name:PENN FAMILY DENTAL INC
Entity type:Organization
Organization Name:PENN FAMILY DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:BIENVENIDO
Authorized Official - Last Name:MINAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-232-7985
Mailing Address - Street 1:1552 TREASURE LK
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-9041
Mailing Address - Country:US
Mailing Address - Phone:814-232-7985
Mailing Address - Fax:
Practice Address - Street 1:473 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15851-1250
Practice Address - Country:US
Practice Address - Phone:814-232-7985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty