=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710060181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES P. GAROFALO, D.D.S., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 THORNTON RD
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15417-9609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-785-8866
-----------------------------------------------------
Fax | 724-785-2184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 THORNTON RD
-----------------------------------------------------
City | BROWNSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15417-9609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-785-8866
-----------------------------------------------------
Fax | 724-785-2184
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JAMES PATRICK GAROFALO
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 724-785-8866
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS-022811-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------