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Individual

DR. GARY LEE KISTNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
2 HOSPITAL DR, TYRONE, PA 16686-1805
(814) 684-2499
Mailing address
405 E SPRINGWOOD PL, PORT MATILDA, PA 16870-7021
(814) 234-9014

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DS022565L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0000789980003
PA
01
438677
UNITED CONCORDIA
PA
Enumeration date
05/15/2007
Last updated
07/09/2007
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