Healthcare Provider Details

I. General information

NPI: 1003438482
Provider Name (Legal Business Name): QUIET VALLEY DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 THERESA LANE
SCIOTA PA
18354
US

IV. Provider business mailing address

104 THERESA LANE
SCIOTA PA
18354
US

V. Phone/Fax

Practice location:
  • Phone: 570-992-7040
  • Fax:
Mailing address:
  • Phone: 570-992-7040
  • Fax:

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: MARK C PUGLIESE
Title or Position: DENTIST
Credential: DMD
Phone: 732-887-2141