Healthcare Provider Details

I. General information

NPI: 1518042969
Provider Name (Legal Business Name): DUBLIN DENTAL CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 NORTH MAIN STREET, SUITE 101
DUBLIN PA
18917-0294
US

IV. Provider business mailing address

PO BOX 294 179 NORTH MAIN STREET, SUITE 101
DUBLIN PA
18917-0294
US

V. Phone/Fax

Practice location:
  • Phone: 215-249-0520
  • Fax: 215-249-0825
Mailing address:
  • Phone: 215-249-0520
  • Fax: 215-249-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDS031336L
License Number StatePA

VIII. Authorized Official

Name: DR. DEAN LOUIS CIROCCO
Title or Position: PRESIDENT / C.E.O.
Credential: D.M.D.
Phone: 215-249-0520