NPIMap

Organization Active NPI

Back Mountain Dental, Inc.

  • General Practice Dentistry
  • Trucksville, PA
National Provider Identifier
1245301381
Registry record updated Nov 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS031113L Issued in PA
Legal business name
BACK MOUNTAIN DENTAL, INC.
Practice address
210 Carverton Rd
Trucksville, PA 18708-1745
Phone
(570) 696-1105
Fax
(570) 696-4805
NPI assigned
Nov 12, 2006
Last updated
Nov 4, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2009

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

Authorized official

Name
Dr. James Clemens Definnis, D.M.DNPI 1578954228
Title
President
Phone
(570) 696-1105

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS031113L PA Primary

Addresses

Primary practice location

210 Carverton Rd
Trucksville, PA 18708-1745

Mailing address

210 Carverton Rd
Trucksville, PA 18708-1745
Phone (570) 696-1105

National Provider Directory

National Provider Directory

Locations

210 Carverton Rd
Trucksville, PA 18708
Phone (570) 696-1105

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": "1163289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257292800000",
    "number": "1245301381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 CARVERTON RD",
            "city": "TRUCKSVILLE",
            "state": "PA",
            "postal_code": "187081745",
            "telephone_number": "570-696-1105",
            "fax_number": "570-696-4805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 CARVERTON RD",
            "city": "TRUCKSVILLE",
            "state": "PA",
            "postal_code": "187081745",
            "telephone_number": "570-696-1105",
            "fax_number": "570-696-4805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK MOUNTAIN DENTAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-12",
        "last_updated": "2009-11-04",
        "status": "A",
        "authorized_official_last_name": "DEFINNIS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "CLEMENS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-696-1105",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS031113L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trucksville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2009; 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.