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Organization
SUSQUEHANNA COMMUNITY HEALTH AND DENTAL CLINIC, INC.
Active
Organization
SUSQUEHANNA COMMUNITY HEALTH AND DENTAL CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELLEN M KRAJEWSKI NPH, CHES (PRESIDENT/CHIEF EXECUTIVE OFFICER)
(570) 567-5412
Entity
Organization
Contact information
Practice address
471 HEPBURN ST, WILLIAMSPORT, PA 17701-6122
(570) 567-5400
(570) 567-5421
Mailing address
471 HEPBURN ST, WILLIAMSPORT, PA 17701-6122
(570) 567-5400
(570) 567-5421
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223D0001X
Public Health Dentistry
—
—
1223G0001X
General Practice Dentistry
—
—
124Q00000X
Dental Hygienist
—
—
126800000X
Dental Assistant
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
03/12/2010
Last updated
10/29/2010
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