MEDICARE: JOSEPH SERAFIN PELLY DDS

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	122300000X	Dentist	DS017449-L	PA

General Provider Information

NPI Number	:	1952478349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH SERAFIN PELLY DDS

Provider Business Mailing Address
First Line	:	20 EAST BROAD ST
Second Line	:
City	:	WEST HAZELTON
State	:	PA
Zip	:	18202
Country	:	US
Telephone Number	:	570-455-8800
Fax Number	:	570-455-1561

Provider Business Practice Location Address
First Line	:	20 EAST BROAD ST
Second Line	:
City	:	WEST HAZELTON
State	:	PA
Zip	:	18202
Country	:	US
Telephone Number	:	570-455-8800
Fax Number	:	570-455-1561

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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