1982601332 NPI number — MIFFLIN-JUNIATA DENTAL CLINIC, INC.

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 1982601332 NPI number — MIFFLIN-JUNIATA DENTAL CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIFFLIN-JUNIATA DENTAL CLINIC, INC.
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:
Provider Other Organization Name Type Code:
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:
1982601332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 S DORCAS ST
Provider Second Line Business Mailing Address:
COMPASS BLDG. SUITE E
Provider Business Mailing Address City Name:
LEWISTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17044-2110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-447-1898
Provider Business Mailing Address Fax Number:
717-447-1891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 S DORCAS ST
Provider Second Line Business Practice Location Address:
COMPASS BLDG. SUITE E
Provider Business Practice Location Address City Name:
LEWISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17044-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-447-1898
Provider Business Practice Location Address Fax Number:
717-447-1891
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KINSLOW
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
717-447-1898

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  D5035955 , 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)

  • Identifier: 0018401110002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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