Provider Demographics
NPI:1104995646
Name:JEANNETTE DENTAL CENTER INC.
Entity type:Organization
Organization Name:JEANNETTE DENTAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MARCELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:724-523-5551
Mailing Address - Street 1:500 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-1915
Mailing Address - Country:US
Mailing Address - Phone:724-523-5551
Mailing Address - Fax:724-523-4738
Practice Address - Street 1:500 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-1915
Practice Address - Country:US
Practice Address - Phone:724-523-5551
Practice Address - Fax:724-523-4738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023747L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA435247OtherUCCI