Healthcare Provider Details

I. General information

NPI: 1023672771
Provider Name (Legal Business Name): CENTURY DENTAL MP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 STERLING RD
MOUNT POCONO PA
18344-1118
US

IV. Provider business mailing address

33 STERLING RD
MOUNT POCONO PA
18344-1118
US

V. Phone/Fax

Practice location:
  • Phone: 570-839-2101
  • Fax: 570-839-2105
Mailing address:
  • Phone: 570-839-2101
  • Fax: 570-839-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. WENDY S SCHUBERT
Title or Position: OFFICE MANAGER
Credential:
Phone: 570-839-2101