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General NPI Number Information
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NPI Number | 1134347933
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Entity Type | Organization
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Legal Business Name | SELINSGROVE DENTAL ARTS
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 504 W PENN ST
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City | SELINSGROVE
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State | PA
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Zip | 17870-1644
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Country | US
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Telephone | 570-374-4625
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Fax | 570-374-0041
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Provider Business Mailing Address
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Address Line | PO BOX 265
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City | SELINSGROVE
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State | PA
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Zip | 17870-0265
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Country | US
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Telephone | 570-374-4625
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Fax | 570-374-0041
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. ANN M ENDERS
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Credential |
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Telephone | 570-374-4655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 28131
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License Number State | PA
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