| Sullivan County Dental Clinic | |
|
217 King Street Laporte PA 18626 | |
| (570) 946-5101 | |
| (570) 946-4341 |
| Full Name | Sullivan County Dental Clinic |
|---|---|
| Speciality | Dentist |
| Location | 217 King Street, Laporte, Pennsylvania |
| Authorized Official Name and Position | James C Rogers (PRESIDENT) |
| Authorized Official Contact | 5709464107 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sullivan County Dental Clinic Po Box 1 Laporte PA 18626-0001 Ph: (570) 946-4107 | Sullivan County Dental Clinic 217 King Street Laporte PA 18626 Ph: (570) 946-5101 |
| NPI Number | 1063704500 |
|---|---|
| Provider Enumeration Date | 05/03/2011 |
| Last Update Date | 05/03/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063704500 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 124Q00000X | Dental Hygienist | (* (Not Available)) | Secondary |