MEDICARE: K&C DENTURE CENTER INC.

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1720172711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K&C DENTURE CENTER INC.

Provider Business Mailing Address
First Line	:	1201 E PLEASANT VALLEY BLVD
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16602-6807
Country	:	US
Telephone Number	:	814-946-8189
Fax Number	:	814-943-4885

Provider Business Practice Location Address
First Line	:	1201 E PLEASANT VALLEY BLVD
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16602-6807
Country	:	US
Telephone Number	:	814-946-8189
Fax Number	:	814-943-4885

Authorized Official
Title or Position	:	DIRECTOR OF PROFESSIONAL RELATIONS
Name	:	MRS. HOLLY JOY LINK
Credential	:
Telephone Number	:	814-946-8189

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/22/2020

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