=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316961733
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID SCOTT TEUFEL DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 HIGH STREET
-----------------------------------------------------
City | WATERFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-796-4813
-----------------------------------------------------
Fax | 814-796-6366
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 395 901 HIGH STREET
-----------------------------------------------------
City | WATERFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-796-4813
-----------------------------------------------------
Fax | 814-796-6366
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS023475L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------