Healthcare Provider Details

I. General information

NPI: 1538386388
Provider Name (Legal Business Name): ASPEN DENTAL ASSOCIATES OF NORTH EASTERN PA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 SCRANTON CARBONDALE HWY
SCRANTON PA
18508-1136
US

IV. Provider business mailing address

PO BOX 3189
SYRACUSE NY
13220-3189
US

V. Phone/Fax

Practice location:
  • Phone: 570-383-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice 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: SHEKAR GUPTA
Title or Position: MCS
Credential:
Phone: 315-454-6000