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Organization
ST LUKE'S PHYSICIAN GROUP INC
Active
Organization
ST LUKE'S PHYSICIAN GROUP INC
Active
Other names
St. Luke's Dental Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
SUE CHIAVAROLI (ENROLLMENT MANAGER)
(484) 526-3569
Entity
Organization
Contact information
Practice address
801 OSTRUM ST, BETHLEHEM, PA 18015-1000
(484) 526-2460
Mailing address
801 OSTRUM ST, BETHLEHEM, PA 18015-1000
(845) 262-4604
(484) 526-2466
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007552510077
—
PW
Enumeration date
11/13/2007
Last updated
08/01/2022
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