Provider Demographics
NPI:1902487655
Name:DOCS DENTAL PR, PC
Entity Type:Organization
Organization Name:DOCS DENTAL PR, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIAING
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-451-4503
Mailing Address - Street 1:6097 EASTON RD
Mailing Address - Street 2:
Mailing Address - City:PIPERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18947-1810
Mailing Address - Country:US
Mailing Address - Phone:813-451-4503
Mailing Address - Fax:
Practice Address - Street 1:606 BUILDING DEPORT RD
Practice Address - Street 2:
Practice Address - City:FT.BUCHANAN
Practice Address - State:PR
Practice Address - Zip Code:00934
Practice Address - Country:US
Practice Address - Phone:813-451-4503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCS DENTAL PR, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental