MEDICARE: ASPEN DENTAL ASSOCIATES OF NORTH EASTERN PA, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1538386388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPEN DENTAL ASSOCIATES OF NORTH EASTERN PA, PC

Provider Business Mailing Address
First Line	:	PO BOX 3189
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13220-3189
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 SCRANTON CARBONDALE HWY
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18508-1136
Country	:	US
Telephone Number	:	570-383-3200
Fax Number	:

Authorized Official
Title or Position	:	MCS
Name	:	SHEKAR GUPTA
Credential	:
Telephone Number	:	315-454-6000

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	08/22/2020

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