Organization
MOOSIC DENTAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NOLEN SCOTT ELY (OWNER)
(570) 344-3500
Entity
Organization
Contact information
Practice address
502 CHURCH STREET, MOOSIC, PA 18507
(570) 344-3500
(570) 344-9442
Mailing address
502 CHURCH STREET, MOOSIC, PA 18507
(570) 344-3500
(570) 344-9442
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS030419L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1014984530002
—
PA
01
—
162464
UNISON
PA
Enumeration date
09/20/2006
Last updated
06/25/2013
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