| State College Orthodontics, P.c. | |
|
2565 Park Center Blvd Suite 300 State College PA 16801-3007 | |
| (814) 308-9504 | |
| (814) 954-7723 |
| Full Name | State College Orthodontics, P.c. |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 2565 Park Center Blvd, State College, Pennsylvania |
| Authorized Official Name and Position | Diane Marie Ray (PRESIDENT) |
| Authorized Official Contact | 8143089504 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State College Orthodontics, P.c. 2565 Park Center Blvd Suite 300 State College PA 16801-3007 Ph: (814) 308-9504 | State College Orthodontics, P.c. 2565 Park Center Blvd Suite 300 State College PA 16801-3007 Ph: (814) 308-9504 |
| NPI Number | 1538468475 |
|---|---|
| Provider Enumeration Date | 03/17/2011 |
| Last Update Date | 02/07/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538468475 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | DS035437 (Pennsylvania) | Primary |
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