# JOHN P COOLICAN DMD, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023405552
- **Authorized official:** DR. JOHN P COOLICAN DMD (PRESIDENT)
- **Authorized official phone:** (570) 343-8166

## Contact information

- **Practice address:** 803 S MAIN AVE, SCRANTON, PA 18504-2757
- **Practice address phone:** (570) 343-8166
- **Practice address fax:** (855) 429-2485
- **Mailing address:** 803 S MAIN AVE, SCRANTON, PA 18504-2757
- **Mailing address phone:** (570) 343-8166
- **Mailing address fax:** (855) 429-2585

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | DS028134L | PA | Yes |

## Other

- **Enumeration date:** 04/22/2015
- **Last updated:** 04/22/2015