Healthcare Provider Details

I. General information

NPI: 1417661620
Provider Name (Legal Business Name): CENTURY DENTAL NS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 W MARKET ST
SCRANTON PA
18508-1536
US

IV. Provider business mailing address

437 W MARKET ST
SCRANTON PA
18508-1536
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-2922
  • Fax: 570-342-7100
Mailing address:
  • Phone: 570-342-2922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DANIELLE WILKES
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 570-766-8803