# NORTHEASTERN DENTAL SPECIALIST PC

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

## Provider details

- **NPI number:** 1497354237
- **Authorized official:** ELAINE E BAGGETT (OFFICE MANAGER)
- **Authorized official phone:** (610) 377-5676

## Contact information

- **Practice address:** 432 S 9TH ST, LEHIGHTON, PA 18235-1812
- **Practice address phone:** (610) 377-5676
- **Practice address fax:** (610) 377-5673
- **Mailing address:** 432 S 9TH ST, LEHIGHTON, PA 18235-1812
- **Mailing address phone:** (610) 377-5676
- **Mailing address fax:** (610) 377-5673

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 10/22/2020
- **Last updated:** 10/30/2020