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Organization

RECONSTRUCTIVE DENTISTRY, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID HAZZOURI DMD (MEDICAL DIRECTOR)
(570) 961-6030
Entity
Organization

Contact information

Practice address
327 N WASHINGTON AVE STE 609, SCRANTON, PA 18503-1539
(570) 961-6030
Mailing address
327 N WASHINGTON AVE STE 609, SCRANTON, PA 18503-1539

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
112193
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
#112193
ACCREDITATION ASSOCIATION FOR AMBULATORY HEALTH CARE, INC. #112193
PA
Enumeration date
05/03/2016
Last updated
05/03/2016
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