Provider Demographics
NPI:1538255856
Name:THOMAS G. LOPATOFSKY, DMD, NICOLE M. QUEZADA, DMD,PC
Entity type:Organization
Organization Name:THOMAS G. LOPATOFSKY, DMD, NICOLE M. QUEZADA, DMD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CLEMENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-724-2565
Mailing Address - Street 1:11671 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-6750
Mailing Address - Country:US
Mailing Address - Phone:570-724-2565
Mailing Address - Fax:570-724-3240
Practice Address - Street 1:11671 ROUTE 6
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-6750
Practice Address - Country:US
Practice Address - Phone:570-724-2565
Practice Address - Fax:570-724-3240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027186L1223G0001X
PADS027194L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty