Healthcare Provider Details

I. General information

NPI: 1336827435
Provider Name (Legal Business Name): DANTE MICHAEL KINTZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1872 ST LUKES BLVD
EASTON PA
18045-5669
US

IV. Provider business mailing address

3320 FOREST ST
LEHIGHTON PA
18235-5818
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-1735
  • Fax:
Mailing address:
  • Phone: 610-657-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberOA006519
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberOA006519
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA006519
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: