Provider Demographics
NPI:1609317478
Name:PELKA ENDODONTICS, LLC
Entity type:Organization
Organization Name:PELKA ENDODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELKA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:914-588-2472
Mailing Address - Street 1:110 REGENT CT
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7966
Mailing Address - Country:US
Mailing Address - Phone:814-234-2428
Mailing Address - Fax:814-231-0118
Practice Address - Street 1:110 REGENT CT
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7966
Practice Address - Country:US
Practice Address - Phone:814-234-2428
Practice Address - Fax:814-231-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0391161223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty