Organization
SUSQUEHANNA FAMILY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW R MCKISSICK DDS (OWNER)
(814) 236-3666
Entity
Organization
Contact information
Practice address
490 SUSQUEHANNA AVE, CURWENSVILLE, PA 16833-1448
(814) 236-3666
(814) 236-3666
Mailing address
490 SUSQUEHANNA AVE, CURWENSVILLE, PA 16833-1448
(814) 236-3666
(814) 236-3666
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101958885006
—
PA
01
—
1982238
UNITED CONCORDIA
—
Enumeration date
02/27/2013
Last updated
02/27/2013
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