| Organization Name: | BRADFORD COUNTY DENTAL HEALTH SERV INC |
| NPI Number: | 1356448864 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBIN A COYLE (DENTAL HYGIENIST CLINICAL MANAGER) |
| Mailing Address: | 1 Progress Plaza Suite #6 Towanda |
| State: | PA US |
| Postal Code: | 188481656 |
| Phone Number: | 5702652069 |
| Fax Number: | 5702658718 |
| NPI Enumeration Date: | 09/19/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |