# ASPEN DENTAL OF SW PENNSYLVANIA, PLLC

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

## Provider details

- **NPI number:** 1215314950
- **Authorized official:** JASON BERTOLLINI (PRS)
- **Authorized official phone:** (866) 273-8204

## Contact information

- **Practice address:** 121 TOWN CENTRE DR, JOHNSTOWN, PA 15904-2824
- **Practice address phone:** (814) 266-5141
- **Practice address fax:** (814) 266-5919
- **Mailing address:** PO BOX 3189, SYRACUSE, NY 13220-3189
- **Mailing address phone:** (866) 273-8204
- **Mailing address fax:** (315) 410-5531

## Taxonomy

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

## Other

- **Enumeration date:** 05/01/2015
- **Last updated:** 05/01/2015