NPIMap

Organization Active NPI

Susquehanna Valley Dental Group PC

  • General Practice Dentistry
  • Middleburg, PA
National Provider Identifier
1699234641
Registry record updated Jun 11, 2019
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SUSQUEHANNA VALLEY DENTAL GROUP PC
Practice address
312 E Main St
Middleburg, PA 17842-1106
Phone
(570) 837-5117
NPI assigned
Mar 19, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Gina Simeone-Gilroy, RDH
Title
Regional Manager
Phone
(570) 655-7645

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

312 E Main St
Middleburg, PA 17842-1106

Mailing address

457 N Main St Ste 100
Pittston, PA 18640-2185
Phone (570) 655-7645

National Provider Directory

National Provider Directory

Locations

312 E Main St
Middleburg, PA 17842
Phone (272) 220-4000

Practitioners & affiliated clinicians

Practitioners 4

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": "1552953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1699234641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "457 N MAIN ST STE 100",
            "city": "PITTSTON",
            "state": "PA",
            "postal_code": "186402185",
            "telephone_number": "570-655-7645",
            "fax_number": "570-299-7427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 E MAIN ST",
            "city": "MIDDLEBURG",
            "state": "PA",
            "postal_code": "178421106",
            "telephone_number": "570-837-5117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA VALLEY DENTAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-19",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "SIMEONE-GILROY",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "REGIONAL MANAGER",
        "authorized_official_telephone_number": "570-655-7645",
        "authorized_official_credential": "RDH"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middleburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.