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432 Rolling Ridge Dr State College PA 16801-7640 | |
| (814) 237-1777 | |
| (814) 237-5245 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 432 Rolling Ridge Dr, State College, Pennsylvania |
| Authorized Official Name and Position | Kim Wilson (CRED SUPERVISOR) |
| Authorized Official Contact | 2175405170 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
432 Rolling Ridge Dr State College PA 16801-7640 Ph: (814) 237-1777 | 432 Rolling Ridge Dr State College PA 16801-7640 Ph: (814) 237-1777 |
| NPI Number | 1609275734 |
|---|---|
| Provider Enumeration Date | 08/14/2014 |
| Last Update Date | 08/14/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609275734 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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