Healthcare Provider Details

I. General information

NPI: 1184758955
Provider Name (Legal Business Name): TONY V. PASQUALE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANTHONY V. PASQUALE DDS

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

IV. Provider business mailing address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

V. Phone/Fax

Practice location:
  • Phone: 570-888-5858
  • Fax:
Mailing address:
  • Phone: 570-888-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number00006-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS036918
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: