Healthcare Provider Details

I. General information

NPI: 1326179615
Provider Name (Legal Business Name): SAMUEL M PRISCO DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 MEADE ST
DUNMORE PA
18512-3169
US

IV. Provider business mailing address

1122 MEADE ST
DUNMORE PA
18512-3169
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-0941
  • Fax: 570-347-3050
Mailing address:
  • Phone: 570-348-0941
  • Fax: 570-347-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SAMUEL M PRISCO
Title or Position: OWNER
Credential: DDS
Phone: 570-348-0941