Organization
PA-FM DENTAL PC
Active
Parent organization
ASPEN DENTAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
ASPEN DENTAL
Authorized official
JASON BERTOLLINI (PRM)
(866) 273-8204
Entity
Organization
Contact information
Practice address
508 BRIGHTON CT, GREENSBURG, PA 15601-9693
(866) 273-8204
(866) 803-4943
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(866) 273-8204
(866) 803-4943
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
29654
PA
Other
Enumeration date
09/09/2013
Last updated
09/09/2013
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