Select Plan Provider Directory - Dominion Dental Services, Inc.

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SELECT PLAN 1 DENTIST DIRECTORY Dentists listed are under contract as of 10/1/12 Last Name First Name Fac ID Dental Office Name Office Address City ST ZIP Discipline County Noel Rubins 002825 Aspen Dental of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General Provider Fayette Ruprecht Heather 002825 Aspen Dental of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General Provider Fayette Shieh Andy 002825 Aspen Dental of Western PA, PC 100 Pricedale Rd. Belle Vernon PA 15012 General Provider Fayette Gates Durwin 001649 Durwin L. Gates, D.M.D. 956 Rostraver Road Belle Vernon PA 15012 General Provider Fayette Barron, Jr Edward 050915 Edward L Barron Jr DDS PC 1730 Rostraver Rd, PO Box 926 Belle Vernon PA 15012 General Provider Fayette Balasubramaniam Ravi 001365 Laurel Highlands Family Dentistry 1952 University Drive Connellsville PA 15425 General Provider Fayette Grimaldi Richard 002573 Richard A. Grimaldi, DMD and Associates 320 Memorial Blvd. Connellsville PA 15425 General Provider Fayette Grimaldi-Farrah Ashleigh 002573 Richard A. Grimaldi, DMD and Associates 320 Memorial Blvd. Connellsville PA 15425 General Provider Fayette Check Jennifer 038052 Aspen Dental 201 Walmart Dr Uniontown PA 15401 General Provider Fayette Ciarallo Robert 038052 Aspen Dental 201 Walmart Dr Uniontown PA 15401 Oral Surgeon Fayette Cignetti Scott 038052 Aspen Dental 201 Walmart Dr Uniontown PA 15401 General Provider Fayette Fazio John 038052 Aspen Dental 201 Walmart Dr Uniontown PA 15401 General Provider Fayette Ferguson III William 038052 Aspen Dental 201 Walmart Dr Uniontown PA 15401 General Provider Fayette Grinberg Anna 038052 Aspen Dental 201 Walmart Dr Uniontown PA 15401 General Provider Fayette Malone Matthew 038052 Aspen Dental 201 Walmart Dr Uniontown PA 15401 General Provider Fayette McCann Eve 038052 Aspen Dental 201 Walmart Dr Uniontown PA 15401 General Provider Fayette McClain Kelly 038052 Aspen Dental 201 Walmart Dr Uniontown PA 15401 General Provider Fayette Monios George 038052 Aspen Dental 201 Walmart Dr Uniontown PA 15401 General Provider Fayette Raja Nabila 038052 Aspen Dental 201 Walmart Dr Uniontown PA 15401 General Provider Fayette Somers Mitchell 038052 Aspen Dental 201 Walmart Dr Uniontown PA 15401 General Provider Fayette Tam Dominic 038052 Aspen Dental 201 Walmart Dr Uniontown PA 15401 General Provider Fayette McKee Laura 015255 Community Dental Services 140 North Beesom Avenue, Suite 400 Uniontown PA 15401 General Provider Fayette McKee Jessica 050956 Cornerstone Inc 140 N Beeson Rd, Suite 400 Uniontown PA 15401 General Provider Fayette McKee Laura 050956 Cornerstone Inc 140 N Beeson Rd, Suite 400 Uniontown PA 15401 General Provider Fayette Howard-Stickel Brandi 001674 Cornerstone Inc 7 Glassworks Rd Greensboro PA 15338 General Provider Greene McKee Jessica 001674 Cornerstone Inc 7 Glassworks Rd Greensboro PA 15338 General Provider Greene McKee Laura 001674 Cornerstone Inc 7 Glassworks Rd Greensboro PA 15338 General Provider Greene Montgomery R Gregory 001674 Cornerstone Inc 7 Glassworks Rd Greensboro PA 15338 General Provider Greene Wilt Rachel 001674 Cornerstone Inc 7 Glassworks Rd Greensboro PA 15338 General Provider Greene Lewis Amy 050955 Cornerstone Inc Mobile Unit 7 Glassworks Rd. Greensboro PA 15338 General Provider Greene Martin Jarrell 050955 Cornerstone Inc Mobile Unit 7 Glassworks Rd. Greensboro PA 15338 General Provider Greene McKee Jessica 050955 Cornerstone Inc Mobile Unit 7 Glassworks Rd. Greensboro PA 15338 General Provider Greene McKee Laura 050955 Cornerstone Inc Mobile Unit 7 Glassworks Rd. Greensboro PA 15338 General Provider Greene Petrilla Gregory 050924 Primary Health Network/Indiana Dental Center 590 Indian Springs Rd Indiana PA 15701 General Provider Indiana Reed John 050924 Primary Health Network/Indiana Dental Center 590 Indian Springs Rd Indiana PA 15701 General Provider Indiana Attri Neellam 002096 Aspen Dental Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna Babameto Blendi 002096 Aspen Dental Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 Oral Surgeon Lackawanna Bannenahally Shruthi 002096 Aspen Dental Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna Botros Samuel 002096 Aspen Dental Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna Chandalada Agastayya 002096 Aspen Dental Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna Chaudhry Ahmad 002096 Aspen Dental Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna Gupta Shekhar 002096 Aspen Dental Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna Harris Chad 002096 Aspen Dental Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna Hu Yu Hui 002096 Aspen Dental Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna Kunam Ramya 002096 Aspen Dental Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna Patel Udaykumar 002096 Aspen Dental Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna Pham Thuy 002096 Aspen Dental Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna Prasad Neralagadde 002096 Aspen Dental Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna Tran Joshua 002096 Aspen Dental Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna Williams Christopher 002096 Aspen Dental Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 General Provider Lackawanna Withanachchi Janatha 002096 Aspen Dental Associates of NE PA PC 1516 Scranton - Carbondale Hwy Scranton PA 18508 Endodontist Lackawanna Babameto Blendi 033853 Aspen Dental Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 Oral Surgeon Lancaster Botros Samuel 033853 Aspen Dental Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster Chandalada Agastayya 033853 Aspen Dental Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster Chaudhry Ahmad 033853 Aspen Dental Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster Gupta Shekhar 033853 Aspen Dental Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster Hamati Isam 033853 Aspen Dental Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster Hu Yu Hui 033853 Aspen Dental Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster Kunam Ramya 033853 Aspen Dental Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster Pham Thuy 033853 Aspen Dental Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster Prasad Neralagadde 033853 Aspen Dental Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster Tran Joshua 033853 Aspen Dental Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster Williams Christopher 033853 Aspen Dental Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 General Provider Lancaster Withanachchi Janatha 033853 Aspen Dental Associates NE PA PLLC 1954 Fruitville Pike Lancaster PA 17601 Endodontist Lancaster * Strause Roger 001341 Centerville Family Dental 803 Estelle Dr. Lancaster PA 17601 General Provider Lancaster Charkas Ahmad 097846 Allied Orthodontics PC 60 W Walnut St Lancaster PA 17602 Orthodontist Lancaster * Indicates dentist that is accepting current patients only. All Select Plan Dentists Page 26 1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.
SELECT PLAN 1 DENTIST DIRECTORY Dentists listed are under contract as of 10/1/12 Last Name First Name Fac ID Dental Office Name Office Address City ST ZIP Discipline County Evans Marianna 097846 Allied Orthodontics PC 60 W Walnut St Lancaster PA 17602 Orthodontist Lancaster O'Donnell Daniel 001720 O'Donnell & Phillips LLC 230 Harrisburg Ave., Suite 5 Lancaster PA 17603 General Provider Lancaster Phillips Jason 001720 O'Donnell & Phillips LLC 230 Harrisburg Ave., Suite 5 Lancaster PA 17603 General Provider Lancaster Charkas Ahmad 070959 Allied Orthodontics PC 1555 Highlands Dr, Suite 190 Lititz PA 17543 Orthodontist Lancaster Evans Marianna 070959 Allied Orthodontics PC 1555 Highlands Dr, Suite 190 Lititz PA 17543 Orthodontist Lancaster Ahmadzadeh Bijan 050977 Lancaster Dental Arts PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General Provider Lancaster Desai Kaushal 050977 Lancaster Dental Arts PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General Provider Lancaster Kopp Anatoliy 050977 Lancaster Dental Arts PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General Provider Lancaster Lam Everest 050977 Lancaster Dental Arts PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General Provider Lancaster Moriarty Sean 050977 Lancaster Dental Arts PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General Provider Lancaster Savani Bhaskar 050977 Lancaster Dental Arts PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General Provider Lancaster Savani Bhumi 050977 Lancaster Dental Arts PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General Provider Lancaster Savani Niranjan 050977 Lancaster Dental Arts PC 1555 Highlands Dr, Suite190 Lititz PA 17543 General Provider Lancaster Lockawich Douglas 001643 Douglas Lockawich, D.M.D. 603 Crescent Avenue Ellwood City PA 16117 General Provider Lawrence * Paige James 001482 James R. Paige, D.D.S. 802 W. Washington Street New Castle PA 16101 General Provider Lawrence Beal Rhonda 001613 Primary Health Network/New Castle Dental Center 2807 Wilmington Rd New Castle PA 16105 General Provider Lawrence Cole Duane 001613 Primary Health Network/New Castle Dental Center 2807 Wilmington Rd New Castle PA 16105 General Provider Lawrence Hartle Sheila 001613 Primary Health Network/New Castle Dental Center 2807 Wilmington Rd New Castle PA 16105 General Provider Lawrence Petrilla Gregory 001613 Primary Health Network/New Castle Dental Center 2807 Wilmington Rd New Castle PA 16105 General Provider Lawrence Reed John 001613 Primary Health Network/New Castle Dental Center 2807 Wilmington Rd New Castle PA 16105 General Provider Lawrence Bui Loc 001343 Mimosa Family Dentistry, P.C. 117 W. Cherry St. Palmyra PA 17078 General Provider Lebanon Bui Toan 001343 Mimosa Family Dentistry, P.C. 117 W. Cherry St. Palmyra PA 17078 General Provider Lebanon Bandelac Georges 070950 A+ Periodontic Specialty Care PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 Periodontist Lehigh Evans Marianna 070950 A+ Periodontic Specialty Care PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 Periodontist Lehigh Charkas Ahmad 070958 Allied Orthodontics PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 Orthodontist Lehigh Evans Marianna 070958 Allied Orthodontics PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 Orthodontist Lehigh Bhatnagar Payal 002358 Aspen Dental Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh Chadha Chandan 002358 Aspen Dental Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh Chaudhry Ahmad 002358 Aspen Dental Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh Kim Peter 002358 Aspen Dental Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh Malhotra Swati 002358 Aspen Dental Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh Obaid Michel 002358 Aspen Dental Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh Rajput Bhumika 002358 Aspen Dental Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh Sambaraju Haritha 002358 Aspen Dental Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh Withanachchi Janatha 002358 Aspen Dental Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 Endodontist Lehigh Yi Tyler 002358 Aspen Dental Associates of NY., P.C. 319 South Cedar Creek Blvd. Allentown PA 18103 General Provider Lehigh Agrawal Avanti 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General Provider Lehigh Derosa Daniel 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General Provider Lehigh Desai Kaushal 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General Provider Lehigh Dormeshian Andrew 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General Provider Lehigh Gombar Anna 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General Provider Lehigh Kopp Anatoliy 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General Provider Lehigh Savani Bhaskar 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General Provider Lehigh Savani Bhumi 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General Provider Lehigh Savani Niranjan 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General Provider Lehigh Todd Meredith 051021 Smile Krafters PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18103 General Provider Lehigh Panossian Antoine 081808 A+ Oral Surgery Specialty Care PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18104 Oral Surgeon Lehigh Tran David 081808 A+ Oral Surgery Specialty Care PC 1247 S Cedar Crest Blvd, Suite 300 Allentown PA 18104 Oral Surgeon Lehigh Ferguson Michele 000635 Gentle Dental Allentown LLC 2015 W Hamilton St., Suite 202 Allentown PA 18104 General Provider Lehigh Halpern Wendy 000635 Gentle Dental Allentown LLC 2015 W Hamilton St., Suite 202 Allentown PA 18104 Periodontist Lehigh Libou Keith 000635 Gentle Dental Allentown LLC 2015 W Hamilton St., Suite 202 Allentown PA 18104 General Provider Lehigh Minetola Mark 000635 Gentle Dental Allentown LLC 2015 W Hamilton St., Suite 202 Allentown PA 18104 General Provider Lehigh Samineni Neelima 000635 Gentle Dental Allentown LLC 2015 W Hamilton St., Suite 202 Allentown PA 18104 General Provider Lehigh Panossian Antoine 070977 A+ Oral Surgery Specialty Care PC 1901 Union Blvd Allentown PA 18109 Oral Surgeon Lehigh Tran David 070977 A+ Oral Surgery Specialty Care PC 1901 Union Blvd Allentown PA 18109 Oral Surgeon Lehigh Bhatnagar Payal 038065 Aspen Dental 1856 Airport Rd Allentown PA 18109 General Provider Lehigh Chadha Chandan 038065 Aspen Dental 1856 Airport Rd Allentown PA 18109 General Provider Lehigh Chaudhry Ahmad 038065 Aspen Dental 1856 Airport Rd Allentown PA 18109 General Provider Lehigh Kim Peter 038065 Aspen Dental 1856 Airport Rd Allentown PA 18109 General Provider Lehigh Malhotra Swati 038065 Aspen Dental 1856 Airport Rd Allentown PA 18109 General Provider Lehigh Obaid Michel 038065 Aspen Dental 1856 Airport Rd Allentown PA 18109 General Provider Lehigh Rajput Bhumika 038065 Aspen Dental 1856 Airport Rd Allentown PA 18109 General Provider Lehigh Sambaraju Haritha 038065 Aspen Dental 1856 Airport Rd Allentown PA 18109 General Provider Lehigh Withanachchi Janatha 038065 Aspen Dental 1856 Airport Rd Allentown PA 18109 Endodontist Lehigh Yi Tyler 038065 Aspen Dental 1856 Airport Rd Allentown PA 18109 General Provider Lehigh Attri Neellam 002883 Aspen Dental Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne * Indicates dentist that is accepting current patients only. All Select Plan Dentists Page 27 1 Same as a DHMO with fixed member copayments, no annual maximum dollar limits, no waiting periods, no deductibles, no pre-authorization paperwork or pre-treatment estimates and no claim forms or proof of loss (except in the case of out-of-area emergencies). Member must enroll with a General Dentist. Fac ID is used to indicate which facility a member chooses.
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Select Plan Provider Directory - Dominion Dental Services, Inc.

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