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General NPI Number Information
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NPI Number | 1215030283
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Entity Type | Organization
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Legal Business Name | PLAZA DENTAL ASSOCIATES PC
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 702 WEST 34TH ST
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City | ERIE
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State | PA
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Zip | 16508
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Country | US
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Telephone | 814-868-5411
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Fax | 814-866-2105
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Provider Business Mailing Address
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Address Line | 702 WEST 34TH ST
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City | ERIE
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State | PA
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Zip | 16508
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Country | US
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Telephone | 814-868-5411
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Fax | 814-866-2105
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Authorized Official
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Title or Position | ASSOCIATE FORMER PARTNER
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Name | DR. JOHN H DAMCOTT
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Credential | DMD
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Telephone | 814-868-5411
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DS016060L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS019797L
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License Number State | PA
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