Healthcare Provider Details

I. General information

NPI: 1770182032
Provider Name (Legal Business Name): ALYSSA A SAPIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 PUBLIC AVE
MONTROSE PA
18801-1219
US

IV. Provider business mailing address

57 PUBLIC AVE
MONTROSE PA
18801-1219
US

V. Phone/Fax

Practice location:
  • Phone: 570-221-9200
  • Fax: 570-221-6640
Mailing address:
  • Phone: 570-221-9200
  • Fax: 570-221-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS045875
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: