Provider Demographics
NPI:1316616493
Name:APPLE DENTAL ASSOCIATE
Entity type:Organization
Organization Name:APPLE DENTAL ASSOCIATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGA
Authorized Official - Middle Name:T
Authorized Official - Last Name:GUNTUPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-546-8888
Mailing Address - Street 1:929 LYCOMING MALL DR.
Mailing Address - Street 2:
Mailing Address - City:PENNSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:17756
Mailing Address - Country:US
Mailing Address - Phone:570-546-8888
Mailing Address - Fax:570-546-7053
Practice Address - Street 1:929 LYCOMING MALL DRIVE
Practice Address - Street 2:
Practice Address - City:PENNSDALE
Practice Address - State:PA
Practice Address - Zip Code:17756
Practice Address - Country:US
Practice Address - Phone:570-546-8888
Practice Address - Fax:570-546-7053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty