# MILL CREEK DENTAL, LLC

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

## Provider details

- **NPI number:** 1134560394
- **Authorized official:** DAVID PELAGIO DMD (DENTIST)
- **Authorized official phone:** (570) 516-9109

## Contact information

- **Practice address:** 497 N CLAUDE A LORD BLVD, POTTSVILLE, PA 17901-2705
- **Practice address phone:** (570) 516-9109
- **Practice address fax:** (570) 516-9138
- **Mailing address:** 497 N CLAUDE A LORD BLVD, POTTSVILLE, PA 17901-2705
- **Mailing address phone:** (570) 516-9109
- **Mailing address fax:** (570) 516-9138

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DS031640L | PA | Yes |

## Other

- **Enumeration date:** 07/16/2013
- **Last updated:** 07/16/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0018499770003 | — | PA |