Healthcare Provider Details

I. General information

NPI: 1265522510
Provider Name (Legal Business Name): DAVID A VRBA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 RIDGE STREET FREELAND HEALTH CENTER
FREELAND PA
18224-1805
US

IV. Provider business mailing address

1084 ROUTE 315
WILKES-BARRE PA
18702-7012
US

V. Phone/Fax

Practice location:
  • Phone: 570-636-1010
  • Fax: 570-636-0985
Mailing address:
  • Phone: 570-825-8741
  • Fax: 570-825-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS021947L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: