# CENTERVILLE CLINICS INS DENTAL

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

## Provider details

- **NPI number:** 1194757559
- **Authorized official:** PATRICIA MARTOS (DIRECTOR FINANCE/PERSONNEL)
- **Authorized official phone:** (724) 632-6801

## Contact information

- **Practice address:** 1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
- **Practice address phone:** (724) 632-1680
- **Mailing address:** 1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
- **Mailing address phone:** (724) 632-1680

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 07/07/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1007288440027 | — | PA |
| 01 | — | 164629 | HIGHMARK | PA |