1245639129 NPI number — MATTHEW SROKA, D.M.D., P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245639129 NPI number — MATTHEW SROKA, D.M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATTHEW SROKA, D.M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HILLTOP DENTAL ASSOCIATES, P.C.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245639129
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1736 LYTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15905-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-255-6831
Provider Business Mailing Address Fax Number:
814-254-1521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1736 LYTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15905-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-255-6831
Provider Business Practice Location Address Fax Number:
814-254-1521
Provider Enumeration Date:
08/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SROKA
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
814-255-6831

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS038685 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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