Healthcare Provider Details

I. General information

NPI: 1073777116
Provider Name (Legal Business Name): CENTRAL PENNSYLVANIA ENDODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S BURROWES ST
STATE COLLEGE PA
16801-4008
US

IV. Provider business mailing address

240 S BURROWES ST
STATE COLLEGE PA
16801-4008
US

V. Phone/Fax

Practice location:
  • Phone: 814-238-4400
  • Fax:
Mailing address:
  • Phone: 814-238-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS029151
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier674228
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUNITED CONCORDIA

VIII. Authorized Official

Name: DR. ROBERT G SAYLOR
Title or Position: CO-OWNER
Credential: DDS
Phone: 814-238-4400