=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669804662
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNTAIN VIEW DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2013
-----------------------------------------------------
Last Update Date | 08/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 239 NORTHERN BLVD SUITE B
-----------------------------------------------------
City | SOUTH ABINGTON TOWNSHIP
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18411-9302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-585-8888
-----------------------------------------------------
Fax | 570-585-8889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 239 NORTHERN BLVD MOUNTAIN VIEW DENTAL
-----------------------------------------------------
City | SOUTH ABINGTON TOWNSHIP
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18411-9302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-585-8888
-----------------------------------------------------
Fax | 570-585-8889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOANNE MARIE THORNE
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 570-585-8888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS030736L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------