Provider Demographics
NPI:1396121455
Name:PARKESBURG FAMILY DENTAL, LLC
Entity type:Organization
Organization Name:PARKESBURG FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZACCARIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-322-0564
Mailing Address - Street 1:4749 W. LINCOLN HWY
Mailing Address - Street 2:WEST SADSBURY SHOPS/OFFICES
Mailing Address - City:PARKESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19365
Mailing Address - Country:US
Mailing Address - Phone:717-442-0739
Mailing Address - Fax:484-712-5232
Practice Address - Street 1:4749 W. LIONCOLN HWY
Practice Address - Street 2:WEST SADSBURY SHOPS/OFFICES
Practice Address - City:PARKESBURG
Practice Address - State:PA
Practice Address - Zip Code:19365
Practice Address - Country:US
Practice Address - Phone:717-442-0739
Practice Address - Fax:484-712-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017468L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental