# IDP PUNXSUTAWNEY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** John Regis Smelko
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245672419
- **Authorized official:** MRS. JULIE SMITH (OPERATIONS FACILITATOR)
- **Authorized official phone:** (231) 739-5105

## Contact information

- **Practice address:** 219 N MAIN ST, PUNXSUTAWNEY, PA 15767-1217
- **Practice address phone:** (814) 938-2222
- **Practice address fax:** (814) 938-0931
- **Mailing address:** 219 N MAIN ST, PUNXSUTAWNEY, PA 15767-1217
- **Mailing address phone:** (814) 938-2222
- **Mailing address fax:** (814) 938-0931

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DS018913L | PA | Yes |

## Other

- **Enumeration date:** 07/29/2013
- **Last updated:** 07/29/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0006936660001 | — | PA |