Organization
SPA DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIE D CROCKER D.D.S. (OWNER)
(814) 398-2656
Entity
Organization
Contact information
Practice address
750 VENANGO AVE, CAMBRIDGE SPRINGS, PA 16403
(814) 398-2656
(814) 398-1438
Mailing address
750 VENANGO AVE, CAMBRIDGE SPRINGS, PA 16403
(814) 398-2656
(814) 398-1438
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS028556L
PA
1223G0001X
General Practice Dentistry
DS017224L
PA
1223G0001X
General Practice Dentistry
DS028556L
PA
Other
Enumeration date
10/23/2006
Last updated
03/09/2011
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