Organization
BACK MOUNTAIN DENTAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES CLEMENS DEFINNIS D.M.D (PRESIDENT)
(570) 696-1105
Entity
Organization
Contact information
Practice address
210 CARVERTON RD, TRUCKSVILLE, PA 18708-1745
(570) 696-1105
(570) 696-4805
Mailing address
210 CARVERTON RD, TRUCKSVILLE, PA 18708-1745
(570) 696-1105
(570) 696-4805
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS031113L
PA
Other
Enumeration date
11/12/2006
Last updated
11/04/2009
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