| Moosic Dental Group Inc | |
|
502 Church Street Moosic PA 18507 | |
| (570) 344-3500 | |
| (570) 344-9442 |
| Full Name | Moosic Dental Group Inc |
|---|---|
| Speciality | Dentist |
| Location | 502 Church Street, Moosic, Pennsylvania |
| Authorized Official Name and Position | Nolen Scott Ely (OWNER) |
| Authorized Official Contact | 5703443500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Moosic Dental Group Inc 502 Church Street Moosic PA 18507 Ph: (570) 344-3500 | Moosic Dental Group Inc 502 Church Street Moosic PA 18507 Ph: (570) 344-3500 |
| NPI Number | 1316044431 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 06/25/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316044431 | NPI | - | NPPES |
| 1014984530002 | Medicaid | PA | |
| 162464 | Other | PA | UNISON |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DS030419L (Pennsylvania) | Primary |