Organization
DENTAL ARTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH REICHARD DMD (DENTIST)
(570) 283-0554
Entity
Organization
Contact information
Practice address
386 NORTHAMPTON ST, EDWARDSVILLE, PA 18704-5448
(570) 283-0554
(570) 283-0555
Mailing address
386 NORTHAMPTON ST, EDWARDSVILLE, PA 18704-5448
(570) 283-0554
(570) 283-0555
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DAO19968L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005285460001
—
PA
Enumeration date
08/24/2011
Last updated
08/24/2011
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