Organization
BRADFORD DENTAL CENTER
Active
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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