Organization
BRADFORD DENTAL CENTER
Active
Parent organization
KEYSTONE RURAL HEALTH CONSORTIA, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
KEYSTONE RURAL HEALTH CONSORTIA, INC
Authorized official
KRISTIE M BENNARDI RN (CEO)
(814) 245-2119
Entity
Organization
Contact information
Practice address
600 CHESTNUT STREET EXT STE B, BRADFORD, PA 16701-5438
(814) 366-5955
(814) 366-5990
Mailing address
PO BOX 270, EMPORIUM, PA 15834-0270
(814) 486-1115
(814) 486-0404
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
09/10/2021
Last updated
09/10/2021
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