Organization
MILL CREEK DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID PELAGIO DMD (DENTIST)
(570) 516-9109
Entity
Organization
Contact information
Practice address
497 N CLAUDE A LORD BLVD, POTTSVILLE, PA 17901-2705
(570) 516-9109
(570) 516-9138
Mailing address
497 N CLAUDE A LORD BLVD, POTTSVILLE, PA 17901-2705
(570) 516-9109
(570) 516-9138
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS031640L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018499770003
—
PA
Enumeration date
07/16/2013
Last updated
07/16/2013
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