Spa Dental Center

Primary specialty

DentistTaxonomy code 122300000X

License

DS028556L Issued in PA

Legal business name

SPA DENTAL CENTER

Practice address

750 Venango Ave
Cambridge Springs, PA 16403

Phone

(814) 398-2656

Fax

(814) 398-1438

NPI assigned

Oct 23, 2006

Last updated

Mar 9, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Marie D Crocker, D.D.S.NPI 1619988037

Title

Owner

Phone

(814) 398-2656

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marie Crocker, DDS

  • General Practice Dentistry
  • Cambridge Springs, PA
  • NPI 1619988037
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299628800000",
    "number": "1013090034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 VENANGO AVE",
            "city": "CAMBRIDGE SPRINGS",
            "state": "PA",
            "postal_code": "16403",
            "telephone_number": "814-398-2656",
            "fax_number": "814-398-1438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 VENANGO AVE",
            "city": "CAMBRIDGE SPRINGS",
            "state": "PA",
            "postal_code": "16403",
            "telephone_number": "814-398-2656",
            "fax_number": "814-398-1438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPA DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2011-03-09",
        "status": "A",
        "authorized_official_last_name": "CROCKER",
        "authorized_official_first_name": "MARIE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-398-2656",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS028556L",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS028556L",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS017224L",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole L. Fies
• S & F Healthcare Inc (Cambridge Springs Pharmacy)
• Lee L Shadeck, LPC
• Chris Shearer
• Zamara Richelle Sheehan Kohler, MA, LPC
• Ashley Stephenson
• Titusville Area Hospital (Cambridge Springs Health Center)
• Danielle Marie Varner, L.P.C.
• Elizabeth Carol Waite, PA-C

• Dentist in Cambridge Springs, PA
• Providers in Cambridge Springs, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.