MEDICARE: DR. DAGMARA VENTRESCA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12012167A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083021687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAGMARA VENTRESCA DDS

Provider Business Mailing Address
First Line	:	11 S MILL ST STE 200
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16101-3680
Country	:	US
Telephone Number	:	724-698-2132
Fax Number	:

Provider Business Practice Location Address
First Line	:	3554 PROMENADE PKWY
Second Line	:	SUITE D
City	:	LAFAYETTE
State	:	IN
Zip	:	47909-8417
Country	:	US
Telephone Number	:	765-838-3550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	10/11/2017

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