Provider Demographics
NPI:1184506701
Name:ROOTED DENTAL, P.C.
Entity type:Organization
Organization Name:ROOTED DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-797-2254
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:PA
Mailing Address - Zip Code:16232-0419
Mailing Address - Country:US
Mailing Address - Phone:814-797-2254
Mailing Address - Fax:814-797-2254
Practice Address - Street 1:524 MAIN ST
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:PA
Practice Address - Zip Code:16232-1916
Practice Address - Country:US
Practice Address - Phone:814-797-2254
Practice Address - Fax:814-797-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty