Healthcare Provider Details

I. General information

NPI: 1326408519
Provider Name (Legal Business Name): HORIZON DENTAL CARE AT STEAMTOWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WYOMING AVE
SCRANTON PA
18503-1238
US

IV. Provider business mailing address

400 WYOMING AVE
SCRANTON PA
18503-1238
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-8800
  • Fax:
Mailing address:
  • Phone: 570-342-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS028534
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOHN EVANISH III
Title or Position: OWNER DOCTOR
Credential: DDS
Phone: 570-342-8800