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Organization
PHILIPSBURG FAMILY DENTISTRY
Active
Organization
PHILIPSBURG FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOLENE J GAVLAK-VAUGHN D.D.S. (OWNER)
(814) 557-5114
Entity
Organization
Contact information
Practice address
109 N CENTRE ST, PHILIPSBURG, PA 16866-1661
(814) 342-1101
Mailing address
PO BOX 60, PHILIPSBURG, PA 16866-0060
(814) 342-1101
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS031452L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001819412
—
PA
Enumeration date
04/28/2008
Last updated
01/28/2016
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