Provider Demographics
NPI:1174549778
Name:PENNS VALLEY DENTAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:PENNS VALLEY DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:814-422-8768
Mailing Address - Street 1:4570 PENNS VALLEY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPRING MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:16875-8500
Mailing Address - Country:US
Mailing Address - Phone:814-422-8768
Mailing Address - Fax:814-422-0379
Practice Address - Street 1:4570 PENNS VALLEY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SPRING MILLS
Practice Address - State:PA
Practice Address - Zip Code:16875-8500
Practice Address - Country:US
Practice Address - Phone:814-422-8768
Practice Address - Fax:814-422-0379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty