# BROAD MOUNTAIN FAMILY DENTISTRY, P.C.

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

## Provider details

- **NPI number:** 1366416828
- **Authorized official:** DR. FRANK JOSEPH BLOZUSKY SR. D.M.D. (CORPORATE PRESIDENT/DENTIST)
- **Authorized official phone:** (570) 874-3981

## Contact information

- **Practice address:** 309 W PINE ST, FRACKVILLE, PA 17931-1211
- **Practice address phone:** (570) 874-3981
- **Practice address fax:** (570) 874-3981
- **Mailing address:** 309 W PINE ST, FRACKVILLE, PA 17931-1211
- **Mailing address phone:** (570) 874-3981
- **Mailing address fax:** (570) 874-3981

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DS-029348-L | PA | Yes |

## Other

- **Enumeration date:** 02/13/2006
- **Last updated:** 08/22/2020