Organization
MINICHELLI DENTISTRY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK RICHARD MINICHELLI D.M.D. (PRESIDENT)
(814) 833-4393
Entity
Organization
Contact information
Practice address
2606 CAUGHEY RD, ERIE, PA 16506-2148
(814) 833-4393
(814) 838-0781
Mailing address
2606 CAUGHEY RD, ERIE, PA 16506-2148
(814) 833-4393
(814) 838-0781
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS027249L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
608515
UCCI
PA
Enumeration date
02/19/2007
Last updated
08/22/2020
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