Healthcare Provider Details

I. General information

NPI: 1982601332
Provider Name (Legal Business Name): MIFFLIN-JUNIATA DENTAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 S DORCAS ST COMPASS BLDG. SUITE E
LEWISTOWN PA
17044-2110
US

IV. Provider business mailing address

31 S DORCAS ST COMPASS BLDG. SUITE E
LEWISTOWN PA
17044-2110
US

V. Phone/Fax

Practice location:
  • Phone: 717-447-1898
  • Fax: 717-447-1891
Mailing address:
  • Phone: 717-447-1898
  • Fax: 717-447-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD5035955
License Number StatePA

VIII. Authorized Official

Name: DONNA J KINSLOW
Title or Position: EXECUTIVE DIRECTOR
Credential: RDH
Phone: 717-447-1898