Bryan P Carlin, DDS
Individual provider Active NPI General Practice Dentistry · Berwick, PA
NPI 1295815686 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1295815686
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DS024135L (PA)
- Practice address
- 105 W 9TH St
Berwick, PA 18603-3024 - Phone
- (570) 752-4542
- Fax
- (570) 752-6806
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective May 7, 2015 through May 7, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS024135L | PA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Berwick Dental Arts Inc | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS024135L | PA | Yes |
Addresses
Primary practice location
105 W 9TH St
Berwick, PA 18603-3024
Mailing address
262 Kachinka Hollow Rd
Berwick, PA 18603-5882
Phone (570) 759-9364
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009751630001 | Medicaid | PA |
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All providers in Berwick, PA · General Practice Dentistry in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.