Organization
AQUELINE ELIZABETH KIRBY MEMORIAL HEALTH CENTER DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DANIELLE CAPPELLINI (EXECUTIVE DIRECTOR)
(570) 822-4178
Entity
Organization
Contact information
Practice address
71 N FRANKLIN ST, WILKES BARRE, PA 18701-1312
(570) 822-4278
(570) 825-9926
Mailing address
71 N FRANKLIN ST, WILKES BARRE, PA 18701-1312
(570) 822-4278
(570) 825-9926
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007139380002
MEDICAL ASSISTANCE
PA
01
—
167782
UNISON
PA
01
—
828141
GATEWAY
PW
Enumeration date
04/17/2007
Last updated
04/29/2015
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