Healthcare Provider Details

I. General information

NPI: 1831264795
Provider Name (Legal Business Name): ROBERT S CESSNA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 LIBERTY ST
PERRYOPOLIS PA
15473
US

IV. Provider business mailing address

PO BOX 60 305 LIBERTY ST
PERRYOPOLIS PA
15473
US

V. Phone/Fax

Practice location:
  • Phone: 724-736-2300
  • Fax:
Mailing address:
  • Phone: 724-736-2300
  • Fax: 724-736-1821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS030870L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: