Provider Demographics
NPI:1912121427
Name:BROWN-MCMULLEN-WISSE DENTAL ASSOCIATES, PC.
Entity Type:Organization
Organization Name:BROWN-MCMULLEN-WISSE DENTAL ASSOCIATES, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-786-2746
Mailing Address - Street 1:316 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566-1138
Mailing Address - Country:US
Mailing Address - Phone:717-786-2746
Mailing Address - Fax:717-786-4872
Practice Address - Street 1:316 W 4TH ST
Practice Address - Street 2:
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566-1138
Practice Address - Country:US
Practice Address - Phone:717-786-2746
Practice Address - Fax:717-786-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty