| Back Mountain Dental, Inc. | |
|
210 Carverton Rd Trucksville PA 18708-1745 | |
| (570) 696-1105 | |
| (570) 696-4805 |
| Full Name | Back Mountain Dental, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 210 Carverton Rd, Trucksville, Pennsylvania |
| Authorized Official Name and Position | James Clemens Definnis (PRESIDENT) |
| Authorized Official Contact | 5706961105 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Back Mountain Dental, Inc. 210 Carverton Rd Trucksville PA 18708-1745 Ph: (570) 696-1105 | Back Mountain Dental, Inc. 210 Carverton Rd Trucksville PA 18708-1745 Ph: (570) 696-1105 |
| NPI Number | 1245301381 |
|---|---|
| Provider Enumeration Date | 11/12/2006 |
| Last Update Date | 11/04/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245301381 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DS031113L (Pennsylvania) | Primary |