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General NPI Number Information
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NPI Number | 1093048217
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Entity Type | Organization
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Legal Business Name | ELECTRIC CITY DENTAL GROUP
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Dates
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Enumeration Date | 09/08/2009
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Last Update Date | 09/08/2009
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Provider Practice Location Address
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Address Line | 117 MAIN ST
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City | FOREST CITY
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State | PA
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Zip | 18421-1440
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Country | US
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Telephone | 570-785-3000
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Fax | 570-785-3175
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Provider Business Mailing Address
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Address Line | 305 SCHOOL SIDE DR
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City | THROOP
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State | PA
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Zip | 18512-1456
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Country | US
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Telephone | 570-383-0784
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD A HARTLAND II
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Credential | DMD
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Telephone | 570-383-0784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS035200
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License Number State | PA
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