Healthcare Provider Details

I. General information

NPI: 1588300263
Provider Name (Legal Business Name): TONI DRISSEL PHDHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 S RAILROAD ST
TAMAQUA PA
18252-1927
US

IV. Provider business mailing address

100 W HIGH ST
NESQUEHONING PA
18240-1518
US

V. Phone/Fax

Practice location:
  • Phone: 570-645-1950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH011251
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: