NPIMap

Organization Active NPI

Broad Mountain Family Dentistry, P.C.

  • General Practice Dentistry
  • Frackville, PA
National Provider Identifier
1366416828
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS-029348-L Issued in PA
Legal business name
BROAD MOUNTAIN FAMILY DENTISTRY, P.C.
Practice address
309 W Pine St
Frackville, PA 17931-1211
Phone
(570) 874-3981
Fax
(570) 874-3981
NPI assigned
Feb 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Frank Joseph Blozusky Sr., D.M.D.NPI 1902981475
Title
Corporate President/Dentist
Phone
(570) 874-3981

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 DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DS-029348-L PA Primary

Addresses

Primary practice location

309 W Pine St
Frackville, PA 17931-1211

Mailing address

309 W Pine St
Frackville, PA 17931-1211
Phone (570) 874-3981

National Provider Directory

National Provider Directory

Locations

309 W Pine St
Frackville, PA 17931
Phone (570) 874-3981

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366416828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 W PINE ST",
            "city": "FRACKVILLE",
            "state": "PA",
            "postal_code": "179311211",
            "telephone_number": "570-874-3981",
            "fax_number": "570-874-3981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 W PINE ST",
            "city": "FRACKVILLE",
            "state": "PA",
            "postal_code": "179311211",
            "telephone_number": "570-874-3981",
            "fax_number": "570-874-3981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD MOUNTAIN FAMILY DENTISTRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BLOZUSKY",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "CORPORATE PRESIDENT/DENTIST",
        "authorized_official_telephone_number": "570-874-3981",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS-029348-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frackville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.