Provider Demographics
NPI:1104906650
Name:BERWICK DENTAL ARTS INC
Entity type:Organization
Organization Name:BERWICK DENTAL ARTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEFINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-752-4542
Mailing Address - Street 1:105 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-3024
Mailing Address - Country:US
Mailing Address - Phone:570-752-4542
Mailing Address - Fax:570-752-6806
Practice Address - Street 1:105 W 9TH ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-3024
Practice Address - Country:US
Practice Address - Phone:570-752-4542
Practice Address - Fax:570-752-6806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005214830001Medicaid
PA187826OtherUNITED CONCORDIA