Organization
DR KATHY PERCOSKY'S GENTLE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHY MARIE PERCOSKY D.D.S. (OWNER)
(814) 535-6458
Entity
Organization
Contact information
Practice address
203 STRAYER ST, JOHNSTOWN, PA 15906-2012
(814) 535-6458
Mailing address
1501 CENTENNIAL DR, WINDBER, PA 15963-8813
(814) 262-7429
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS028979L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0019507300001
MEDICAL ASSISTANCE
PA
01
—
86013
UNITED CONCORDIA
PA
Enumeration date
11/22/2006
Last updated
08/22/2020
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