Healthcare Provider Details

I. General information

NPI: 1518183466
Provider Name (Legal Business Name): JOSEPH J SAILUS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 STATE ROUTE 611 BARTONSVILLE COMMONS SUITE #4
BARTONSVILLE PA
18321
US

IV. Provider business mailing address

102 STATE ROUTE 611 BARTONSVILLE COMMONS SUITE #4
BARTONSVILLE PA
18321
US

V. Phone/Fax

Practice location:
  • Phone: 570-629-8001
  • Fax: 570-629-8821
Mailing address:
  • Phone: 570-629-8001
  • Fax: 570-629-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS021979L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: