| Nicholas J Fedorka Dmd Pc | |
|
505 Poplar Street Meadville PA 16335 | |
| (814) 333-4454 | |
| (814) 336-3357 |
| Full Name | Nicholas J Fedorka Dmd Pc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Pathology |
| Location | 505 Poplar Street, Meadville, Pennsylvania |
| Authorized Official Name and Position | Nicholas Jerome Fedorka (OWNER ORAL & MAXILLOFACIAL SURGEON) |
| Authorized Official Contact | 8143363357 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicholas J Fedorka Dmd Pc 505 Poplar Street Meadville PA 16335 Ph: (814) 333-4454 | Nicholas J Fedorka Dmd Pc 505 Poplar Street Meadville PA 16335 Ph: (814) 333-4454 |
| NPI Number | 1265571426 |
|---|---|
| Provider Enumeration Date | 02/05/2007 |
| Last Update Date | 10/02/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265571426 | NPI | - | NPPES |
| 0008854040002 | Medicaid | PA | |
| 0008854040004 | Medicaid | PA | |
| 134372 | Other | HIGHMARK BCBS | |
| 103082 | Other | UPMC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | DS023205L (Pennsylvania) | Primary |
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