Moosic Dental Group Inc

Primary specialty

DentistTaxonomy code 122300000X

License

DS030419L Issued in PA

Legal business name

MOOSIC DENTAL GROUP INC

Practice address

502 Church Street
Moosic, PA 18507

Phone

(570) 344-3500

Fax

(570) 344-9442

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Nolen Scott Ely

Title

Owner

Phone

(570) 344-3500

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Travis Edward Perry, D.D.S

  • Dentist
  • Moosic, PA
  • NPI 1104266824
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372118400000",
    "number": "1316044431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 CHURCH STREET",
            "city": "MOOSIC",
            "state": "PA",
            "postal_code": "18507",
            "telephone_number": "570-344-3500",
            "fax_number": "570-344-9442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 CHURCH STREET",
            "city": "MOOSIC",
            "state": "PA",
            "postal_code": "18507",
            "telephone_number": "570-344-3500",
            "fax_number": "570-344-9442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOOSIC DENTAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2013-06-25",
        "status": "A",
        "authorized_official_last_name": "ELY",
        "authorized_official_first_name": "NOLEN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-344-3500"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS030419L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1014984530002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "162464",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sean Patrick McDonough, LSW
• Deirdre Kathleen McGreevy, MSW, LCSW, CEAP
• Lori Ann Mercatili Cimino, MSCCC-SLP
• April Mercier
• Justine M Metcho, DPM
• Moosic Hose Co Ambulance
• Martin Thomas Munley Jr., DC
• Peter Nallin, DC
• Kristie Marie Nardell, M.D.
• Kelsey Gail Nataupsky, LMFT

• Dentist in Moosic, PA
• Providers in Moosic, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; 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.