NPIMap

Organization Active NPI

North Penn Comprehensive Health Services

Doing business as Laurel Dental - Towanda

  • Federally Qualified Health Center (FQHC)
  • Towanda, PA
National Provider Identifier
1184357329
Registry record updated Jul 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTH PENN COMPREHENSIVE HEALTH SERVICES
Doing business as
Laurel Dental - Towanda
Practice address
346 York Ave
Towanda, PA 18848-2021
Phone
(570) 662-1945
Fax
(570) 662-2390
NPI assigned
Jul 6, 2022
Last updated
Jul 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2022

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

Authorized official

Name
Ronald Meryl Gilbert
Title
Cfo
Phone
(570) 662-1945

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

346 York Ave
Towanda, PA 18848-2021

Mailing address

40 W Wellsboro St
Mansfield, PA 16933-1411
Phone (570) 662-1945

Other names 1

  • Laurel Dental - Towanda Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221024001482 PA Part A Provider - Federally Qualified Health Center (FQHC) 0446245880 Practice locations: Towanda, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184357329. Details of each certification follow.

Federally qualified health center certification: CCN 391043

Legal name
NORTH PENN COMPREHENSIVE HEALTH SERVICES
Doing business as
LAUREL DENTAL - TOWANDA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 18, 2022
Last certification
Oct 18, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 10, 1972 in PA
Enrollment address
346 York Ave
Towanda, PA 18848-2021

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

National Provider Directory

National Provider Directory
Tax ID family
North Penn Comp Health14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

346 York Ave
Towanda, PA 18848
Phone (570) 265-3996

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Scott D Myers Individual Corporate DirectorBoard Member Apr 1, 2025
John Dennis Murray Individual Corporate Director Jul 1, 1986
Donna R Wilson Individual Corporate Director Jul 1, 1993
Sean Sember Individual Corporate DirectorBoard Member Sep 22, 2021
James a Nobles Individual Corporate OfficerCeo Mar 5, 2018
Corporate DirectorCeo Mar 5, 2018
OtherCeo Mar 5, 2018
Thomas Thompson Individual Corporate OfficerTreasurer Jan 1, 2022
Jody Thomas Individual Corporate Director Jul 1, 2019
Megan Wells-Williams Individual Corporate DirectorBoard Member Jul 7, 2021
Kelly Irwin Individual Corporate DirectorBoard Member Jan 1, 2023
Ronald M Gilbert Individual Corporate OfficerCfo Aug 14, 2015
Corporate DirectorCfo Aug 14, 2015
W-2 Managing Employee Aug 14, 2015
Kimberly Johns Individual Corporate DirectorBoard Member Jan 1, 2022
Kristopher Kaufman Individual Corporate DirectorBoard Member Jan 1, 2022
Darla Bortz Individual Corporate DirectorBoard Member Apr 1, 2025
Jason Krise Individual Corporate OfficerChairman Jan 1, 2021
Corporate Director Jan 1, 2021

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1657065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657756800000",
    "number": "1184357329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 W WELLSBORO ST",
            "city": "MANSFIELD",
            "state": "PA",
            "postal_code": "169331411",
            "telephone_number": "570-662-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "346 YORK AVE",
            "city": "TOWANDA",
            "state": "PA",
            "postal_code": "188482021",
            "telephone_number": "570-662-1945",
            "fax_number": "570-662-2390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH PENN COMPREHENSIVE HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-06",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A",
        "authorized_official_last_name": "GILBERT",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "MERYL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "570-662-1945"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laurel Dental - Towanda",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Towanda, PA

Sources for this page

Verify at the official NPI Registry.