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 Babameto Blendi 002883 Aspen Dental Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 Oral Surgeon Luzerne Bannenahally Shruthi 002883 Aspen Dental Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne Botros Samuel 002883 Aspen Dental Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne Chandalada Agastayya 002883 Aspen Dental Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne Chaudhry Ahmad 002883 Aspen Dental Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne Gupta Shekhar 002883 Aspen Dental Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne Harris Chad 002883 Aspen Dental Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne Hu Yu Hui 002883 Aspen Dental Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne Kunam Ramya 002883 Aspen Dental Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne Patel Udaykumar 002883 Aspen Dental Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne Pham Thuy 002883 Aspen Dental Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne Prasad Neralagadde 002883 Aspen Dental Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne Sambaraju Haritha 002883 Aspen Dental Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne Tran Joshua 002883 Aspen Dental Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 General Provider Luzerne Withanachchi Janatha 002883 Aspen Dental Associates of NEPA, PLLC 741 Airport Rd. Hazle Township PA 18202 Endodontist Luzerne Albertine Joseph 001722 Joseph Albertine DDS 239 Muir Ave. Hazleton PA 18201 General Provider Luzerne Jacques Denis 001807 Pittston Dental Center 34 S. Main St. Pittston PA 18640 General Provider Luzerne Polter Joel 001807 Pittston Dental Center 34 S. Main St. Pittston PA 18640 General Provider Luzerne LaFoca Santo 001724 Santo LaFoca, D.M.D. 20 N. Main St. Pittston PA 18640 General Provider Luzerne Smith Eric 001724 Santo LaFoca, D.M.D. 20 N. Main St. Pittston PA 18640 General Provider Luzerne Specter James 000667 Oral Surgery Associates of Wyoming Valley, Inc. 34 South Main Street Wilkes Barre PA 18701 Oral Surgeon Luzerne Zampetti Ralph 000667 Oral Surgery Associates of Wyoming Valley, Inc. 34 South Main Street Wilkes Barre PA 18701 Oral Surgeon Luzerne Babameto Blendi 002240 Aspen Dental Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 Oral Surgeon Luzerne Botros Samuel 002240 Aspen Dental Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne Chandalada Agastayya 002240 Aspen Dental Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne Hamati Isam 002240 Aspen Dental Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne Hu Yu Hui 002240 Aspen Dental Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne Noel Rubins 002240 Aspen Dental Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne Patel Udaykumar 002240 Aspen Dental Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne Pham Thuy 002240 Aspen Dental Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne Tran Joshua 002240 Aspen Dental Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne Williams Christopher 002240 Aspen Dental Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 General Provider Luzerne Withanachchi Janatha 002240 Aspen Dental Associates of NE PA PLLC 2168 Wilkes-Barre Township, Market Place Wilkes Barre PA 18702 Endodontist Luzerne Walthour William 000483 William Walthour, D.D.S. 213 East Market Street Wilkes Barre PA 18702 General Provider Luzerne Mastrini Louis 000386 Louis J. Mastrini, D.D.S. 672 North River St, Suite 209 Wilkes Barre PA 18705 General Provider Luzerne Babameto Blendi 038097 Aspen Dental Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 Oral Surgeon Lycoming Botros Samuel 038097 Aspen Dental Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General Provider Lycoming Chandalada Agastayya 038097 Aspen Dental Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General Provider Lycoming Ciarallo Robert 038097 Aspen Dental Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 Oral Surgeon Lycoming Harris Chad 038097 Aspen Dental Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General Provider Lycoming Hu Yu Hui 038097 Aspen Dental Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General Provider Lycoming Pham Thuy 038097 Aspen Dental Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General Provider Lycoming Tran Joshua 038097 Aspen Dental Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General Provider Lycoming Williams Christopher 038097 Aspen Dental Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 General Provider Lycoming Withanachchi Janatha 038097 Aspen Dental Associates of NE PA PC 340 S Lycoming Mall Rd, Suite 10 Muncy PA 17756 Endodontist Lycoming Cosgrove William 001611 Primary Health Network/Farrell Dental Center 350 Sharon-New Castle Road Farrell PA 16121 General Provider Mercer Jeffries Christian 001611 Primary Health Network/Farrell Dental Center 350 Sharon-New Castle Road Farrell PA 16121 General Provider Mercer Reed John 001611 Primary Health Network/Farrell Dental Center 350 Sharon-New Castle Road Farrell PA 16121 General Provider Mercer Richards H. Lawrence 001611 Primary Health Network/Farrell Dental Center 350 Sharon-New Castle Road Farrell PA 16121 General Provider Mercer Conquest Matthew 050986 Snyder and Dugan Oral Maxillofacial Surgery 2 Greenville Orthopedic Center Greenville PA 16125 Oral Surgeon Mercer Dugan Michael 050986 Snyder and Dugan Oral Maxillofacial Surgery 2 Greenville Orthopedic Center Greenville PA 16125 Oral Surgeon Mercer Snyder Richard 050986 Snyder and Dugan Oral Maxillofacial Surgery 2 Greenville Orthopedic Center Greenville PA 16125 Oral Surgeon Mercer Sweeney Patrick 050986 Snyder and Dugan Oral Maxillofacial Surgery 2 Greenville Orthopedic Center Greenville PA 16125 Oral Surgeon Mercer Kampas Ronald 080782 Kampas Orthodontics PC 133 S Broad St Grove City PA 16127 Orthodontist Mercer Cernansky Jaime 037714 Snyder and Dugar Oral and Maxillofacial Surgery 112 S. Broad St Grove City PA 16127 Oral Surgeon Mercer Conquest Matthew 037714 Snyder and Dugar Oral and Maxillofacial Surgery 112 S. Broad St Grove City PA 16127 Oral Surgeon Mercer Dugan Michael 037714 Snyder and Dugar Oral and Maxillofacial Surgery 112 S. Broad St Grove City PA 16127 Oral Surgeon Mercer Snyder Richard 037714 Snyder and Dugar Oral and Maxillofacial Surgery 112 S. Broad St Grove City PA 16127 Oral Surgeon Mercer Sweeney Patrick 037714 Snyder and Dugar Oral and Maxillofacial Surgery 112 S. Broad St Grove City PA 16127 Oral Surgeon Mercer Aboosi Omar 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer Bajaj Smriti 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer Barber Timothy 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer Bonczek Brian 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer Budhiraj Anisha 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer Ciarallo Robert 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 Oral Surgeon Mercer Fnu Snigdha 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer * Indicates dentist that is accepting current patients only. All Select Plan Dentists Page 28 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 Ginde Mayura 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer Grinberg Anna 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer Khalil Mirette 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer Liska Emily 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer Masown Surinder 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer Noel Rubins 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer Poleski Kenneth 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer Ruprecht Heather 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer Saba Christopher 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer Smith Christine 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer Wood Justin 002882 Aspen Dental Associates of Western PA PC 1049 N. Hermitage Rd. Hermitage PA 16148 General Provider Mercer Pitts LaTonya 002159 LaTonya E Pitts DDS 40 Chestnut Street Lewistown PA 17044 General Provider Mifflin Babameto Blendi 002671 Aspen Dental Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 Oral Surgeon Monroe Botros Samuel 002671 Aspen Dental Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe Chandalada Agastayya 002671 Aspen Dental Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe Gupta Shekhar 002671 Aspen Dental Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe Hu Yu Hui 002671 Aspen Dental Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe Noel Rubins 002671 Aspen Dental Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe Pham Thuy 002671 Aspen Dental Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe Tran Joshua 002671 Aspen Dental Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe Williams Christopher 002671 Aspen Dental Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 General Provider Monroe Withanachchi Janatha 002671 Aspen Dental Associates of NE PA PC 1112 A North Ninth Street Stroudsburg PA 18360 Endodontist Monroe Dudhat Dilip 002810 Abington Dental Excellence 1130 Old York Rd Abington PA 19001 General Provider Montgomery Griffith Robert 000653 Abington Oral and Maxillofacial Surgery, P.C. 1235 Old York Road, Ste 122, Levy Medical Plaza Abington PA 19001 Oral Surgeon Montgomery Ireland Charles 050921 Dr Charles S Ireland III PC 2400 Pershing Ave Abington PA 19001 General Provider Montgomery Cichetti Michael 070995 Cichetti & DelliGatti Orthodontics PC 7 E Skippack Pike, Suite 105 Ambler PA 19002 Orthodontist Montgomery DelliGatti Steve 070995 Cichetti & DelliGatti Orthodontics PC 7 E Skippack Pike, Suite 105 Ambler PA 19002 Orthodontist Montgomery Milewski Michael 070995 Cichetti & DelliGatti Orthodontics PC 7 E Skippack Pike, Suite 105 Ambler PA 19002 Orthodontist Montgomery Orozco Jacob 070995 Cichetti & DelliGatti Orthodontics PC 7 E Skippack Pike, Suite 105 Ambler PA 19002 Orthodontist Montgomery Bahn Paul 070986 Pediatric Dental Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery D'Agostino Alegra 070986 Pediatric Dental Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery Hamilton Sharon 070986 Pediatric Dental Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery Kay Lewis 070986 Pediatric Dental Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery Quinn Noah 070986 Pediatric Dental Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery Rosenbaum Michael 070986 Pediatric Dental Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery Thomas Kimberly 070986 Pediatric Dental Associates 7 E Skippack Pike Ambler PA 19002 Pedodontist Montgomery Panossian Antoine 070976 A+ Oral Surgery Specialty Care PC 301 City Line Ave, Suite G 5 Bala Cynwyd PA 19004 Oral Surgeon Montgomery Tran David 070976 A+ Oral Surgery Specialty Care PC 301 City Line Ave, Suite G 5 Bala Cynwyd PA 19004 Oral Surgeon Montgomery Charkas Ahmad 070954 Allied Orthodontics PC 301 City Line Ave, Suite G 5 Bala Cynwyd PA 19004 Orthodontist Montgomery Evans Marianna 070954 Allied Orthodontics PC 301 City Line Ave, Suite G 5 Bala Cynwyd PA 19004 Orthodontist Montgomery Adams Michael 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Bruno Frank 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Endodontist Montgomery Chen Yang 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Cohen Hal 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Daly Gerald 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery David Dan 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Edmonds R Blake 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Elkhatib Mohammad 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Fluhr Howard 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Gelbart Steven 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Kim Jae Woo 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Kim Steven 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Periodontist Montgomery Koff Howard 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Orthodontist Montgomery Levy Jamie 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Oral Surgeon Montgomery Li Fuming 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Lu John 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Periodontist Montgomery Mojahed Amir 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Mumtaz Samera 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Nguyen Diep 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Oh Jinsuk 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Pereia Christine 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Roth Michael 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Orthodontist Montgomery Ruggieri John 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Sacks Frederick 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 Oral Surgeon Montgomery Sandhu Satinder 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery Sanfacon Dennis 002796 American Dental Care, PC 187 W City Line Ave Bala Cynwyd PA 19004 General Provider Montgomery * Indicates dentist that is accepting current patients only. All Select Plan Dentists Page 29 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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