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Organization
AQUELINE ELIZABETH KIRBY MEMORIAL HEALTH CENTER DENTAL CLINIC
Active
Organization
AQUELINE ELIZABETH KIRBY MEMORIAL HEALTH CENTER DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DANIELLE CAPPELLINI (EXECUTIVE DIRECTOR)
(570) 822-4178
Entity
Organization
Contact information
Practice address
71 N FRANKLIN ST, WILKES BARRE, PA 18701-1312
(570) 822-4278
(570) 825-9926
Mailing address
71 N FRANKLIN ST, WILKES BARRE, PA 18701-1312
(570) 822-4278
(570) 825-9926
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007139380002
MEDICAL ASSISTANCE
PA
01
—
167782
UNISON
PA
01
—
828141
GATEWAY
PW
Enumeration date
04/17/2007
Last updated
04/29/2015
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