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General NPI Number Information
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NPI Number | 1609718006
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Entity Type | Organization
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Legal Business Name | CCA DENTAL GROUP LLC
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Dates
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Enumeration Date | 04/07/2026
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Last Update Date | 04/07/2026
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Provider Practice Location Address
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Address Line | 5158 PEACH ST # 110
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City | ERIE
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State | PA
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Zip | 16509-2489
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Country | US
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Telephone | 814-868-3647
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Fax | 814-864-2715
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Provider Business Mailing Address
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Address Line | 5158 PEACH ST # 110
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City | ERIE
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State | PA
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Zip | 16509-2489
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Country | US
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Telephone | 814-868-3647
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Fax | 814-864-2715
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Authorized Official
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Title or Position | MANAGER
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Name | DR. CORTNEY ARCHBOLD
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Credential | DDS
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Telephone | 814-868-3647
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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 |
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License Number State |
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