Healthcare Provider Details

I. General information

NPI: 1922912013
Provider Name (Legal Business Name): ADVANCED DENTISTRY IMPLANTS DENTURES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 N SUSQUEHANNA TRL STE 2
SELINSGROVE PA
17870-7783
US

IV. Provider business mailing address

1499 N SUSQUEHANNA TRL STE 2
SELINSGROVE PA
17870-7783
US

V. Phone/Fax

Practice location:
  • Phone: 570-884-4000
  • Fax: 570-844-8770
Mailing address:
  • Phone: 570-884-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: CAROLYN BATES
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 716-622-1592