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General NPI Number Information
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NPI Number | 1356677868
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Entity Type | Organization
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Legal Business Name | SUSQUEHANNA RIVER VALLEY DENTAL HEALTH CLINIC
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Dates
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Enumeration Date | 10/19/2009
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Last Update Date | 10/19/2009
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Provider Practice Location Address
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Address Line | 335 MARKET ST SUITE ONE
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City | SUNBURY
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State | PA
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Zip | 17801-3411
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Country | US
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Telephone | 570-286-7500
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Fax | 570-286-1524
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Provider Business Mailing Address
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Address Line | 335 MARKET ST SUITE ONE
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City | SUNBURY
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State | PA
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Zip | 17801-3411
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Country | US
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Telephone | 570-286-7500
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Fax | 570-286-1524
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Authorized Official
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Title or Position | CHAIRMAN BOARD OF DIRECTORS
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Name | DR. PHIL SOSLAND
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Credential | DDS
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Telephone | 570-524-2729
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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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