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General NPI Number Information
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NPI Number | 1013999465
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Entity Type | Organization
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Legal Business Name | CENTERVILLE CLINICS INC
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 208 S ARCH ST
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City | CONNELLSVILLE
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State | PA
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Zip | 15425-3519
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Country | US
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Telephone | 724-626-2630
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Fax | 724-626-2655
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Provider Business Mailing Address
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Address Line | 1070 OLD NATIONAL PIKE
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City | FREDERICKTOWN
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State | PA
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Zip | 15333-2114
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Country | US
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Telephone | 724-632-6801
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Fax | 724-632-6312
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE/PERSONNEL
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Name | MRS. PATRICIA MARTOS
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Credential |
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Telephone | 724-632-6801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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