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 Evans Marianna 070933 Allied Orthodontics PC 8355 Loretto Ave, Suite 104 Philadelphia PA 19152 Orthodontist Philadelphia Podray Brad 070933 Allied Orthodontics PC 8355 Loretto Ave, Suite 104 Philadelphia PA 19152 Orthodontist Philadelphia Pruzansky Dawn 070933 Allied Orthodontics PC 8355 Loretto Ave, Suite 104 Philadelphia PA 19152 Orthodontist Philadelphia Kondratyeva Natalya 001183 Magic Dental Systems 8253 Bustleton Ave. Philadelphia PA 19152 General Provider Philadelphia Rybak Marina 001183 Magic Dental Systems 8253 Bustleton Ave. Philadelphia PA 19152 General Provider Philadelphia Agrawal Avanti 068500 A 1 Family Dental Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia Derosa Daniel 068500 A 1 Family Dental Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia Desai Kaushal 068500 A 1 Family Dental Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia Gombar Anna 068500 A 1 Family Dental Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia Hoang Mark 068500 A 1 Family Dental Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia Hwang Sookie 068500 A 1 Family Dental Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia Kopp Anatoliy 068500 A 1 Family Dental Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia Purtuc Cynthia 068500 A 1 Family Dental Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia Savani Bhaskar 068500 A 1 Family Dental Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia Savani Bhumi 068500 A 1 Family Dental Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia Savani Niranjan 068500 A 1 Family Dental Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia Thoma Fjoralba 068500 A 1 Family Dental Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia Todd Meredith 068500 A 1 Family Dental Care PC 12301 Academy Rd, Suite 201-202 Philadelphia PA 19154 General Provider Philadelphia Paul Prolay 050726 Franklin Mills Mall Dental 1120 Franklin Mills Cir Philadelphia PA 19154 General Provider Philadelphia Shah Shreyas 050726 Franklin Mills Mall Dental 1120 Franklin Mills Cir Philadelphia PA 19154 General Provider Philadelphia Frankel Harvey 001553 Harvey Frankel, D.M.D. 614 S. Franklin Avenue Somerset PA 15501 Pedodontist Somerset Bott Robert 001228 Robert P. Bott, D.M.D. The Professional Bld, Main Street Avella PA 15312 General Provider Washington Pasqual Harry 001250 Pasqual Associates 3001 Waterdam Plaza Dr. Canonsburg PA 15317 Oral Surgeon Washington Adams William 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Affolter John 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Alagirisamy Kiruthika 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Carozza Roselyn 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Cohen Ira 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Dahar Nicholas 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington Damich Louis 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Ghaffari Catherine 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Ghajarnia M. Reza 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington Gillen Steve 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Iszkula Steven 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington Katsur James 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Khurana Leena 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Kier Calvin 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington King David 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington Kolla Siva 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Lewis Howell 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington Miller Van 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington Pryor Leroy 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Rinchuse Dara 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 Orthodontist Washington Schmidt Alan 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Smiga Ingrid 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Stein Mark 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Tinnemeyer Anjuli 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Zalakar Frank 001073 Katsur Dental & Orthodontics 661 McKean Avenue Donora PA 15033 General Provider Washington Dandashi Moutaz 050689 Katsur Dental & Orthodontics Specialists 661 McKean Ave Donora PA 15033 Pedodontist Washington Hertzler L Gregory 050689 Katsur Dental & Orthodontics Specialists 661 McKean Ave Donora PA 15033 Oral Surgeon Washington Kelly Derek 050689 Katsur Dental & Orthodontics Specialists 661 McKean Ave Donora PA 15033 Oral Surgeon Washington Kier Gregory 050689 Katsur Dental & Orthodontics Specialists 661 McKean Ave Donora PA 15033 Periodontist Washington Monti Richard 050689 Katsur Dental & Orthodontics Specialists 661 McKean Ave Donora PA 15033 Oral Surgeon Washington Manalo Arsenio 001491 McMurray Dental 4143 Washington Road, Waterdam Centre McMurray PA 15317 General Provider Washington Pruce Robert 001442 Robert L. Pruce, D.M.D. 608 East McMurray Road McMurray PA 15317 General Provider Washington * Roth Gilbert 001632 Waterdam Dental Associates, P.C. 161 Waterdam Rd., Suite 250 McMurray PA 15317 General Provider Washington Roth Gilbert 001633 Waterdam Dental Associates, P.C. 2 Mill Street Millsboro PA 15348 General Provider Washington Rodriguez Randall 001606 Randall Rodriguez, D.M.D. 173 W Main St Monongahela PA 15063 General Provider Washington Adams William 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington Affolter John 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington Alagirisamy Kiruthika 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington Carozza Roselyn 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington Cohen Ira 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington Dahar Nicholas 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington Damich Louis 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington Ghaffari Catherine 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington * Indicates dentist that is accepting current patients only. All Select Plan Dentists Page 40 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 Ghajarnia M. Reza 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington Gillen Steve 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington Iszkula Steven 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington Katsur James 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington Khurana Leena 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington Kier Calvin 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington King David 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington Kolla Siva 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington Lewis Howell 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington Miller Van 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington Pryor Leroy 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington Rinchuse Dara 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 Orthodontist Washington Schmidt Alan 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington Smiga Ingrid 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington Stein Mark 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington Zalakar Frank 000984 Katsur Dental & Orthodontics Rte. 19, North Gate Plaze Washington PA 15301 General Provider Washington Dandashi Moutaz 050695 Katsur Dental & Orthodontics Specialists Northgate Plaza, Route 19 Washington PA 15301 Pedodontist Washington Hertzler L Gregory 050695 Katsur Dental & Orthodontics Specialists Northgate Plaza, Route 19 Washington PA 15301 Oral Surgeon Washington Kelly Derek 050695 Katsur Dental & Orthodontics Specialists Northgate Plaza, Route 19 Washington PA 15301 Oral Surgeon Washington Kier Gregory 050695 Katsur Dental & Orthodontics Specialists Northgate Plaza, Route 19 Washington PA 15301 Periodontist Washington Monti Richard 050695 Katsur Dental & Orthodontics Specialists Northgate Plaza, Route 19 Washington PA 15301 Oral Surgeon Washington Lucyk-Pavasko Lauren 001607 David H.J. Pavasko, D.M.D. 4810 Old William Penn Highway, Suite 4 Export PA 15632 General Provider Westmoreland Pavasko David 001607 David H.J. Pavasko, D.M.D. 4810 Old William Penn Highway, Suite 4 Export PA 15632 General Provider Westmoreland Nista Mark 068481 Nista Family Dental Center PC 105 Pfeffer Rd, Suite 2 Export PA 15632 General Provider Westmoreland Check Jennifer 040243 Aspen Dental 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland Ciarallo Robert 040243 Aspen Dental 6088 Route 30 Greensburg PA 15601 Oral Surgeon Westmoreland Cignetti Scott 040243 Aspen Dental 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland Fazio John 040243 Aspen Dental 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland Ferguson III William 040243 Aspen Dental 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland Grinberg Anna 040243 Aspen Dental 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland Khalil Mirette 040243 Aspen Dental 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland Malone Matthew 040243 Aspen Dental 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland McCann Eve 040243 Aspen Dental 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland McClain Kelly 040243 Aspen Dental 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland Monios George 040243 Aspen Dental 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland Raja Nabila 040243 Aspen Dental 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland Somers Mitchell 040243 Aspen Dental 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland Tam Dominic 040243 Aspen Dental 6088 Route 30 Greensburg PA 15601 General Provider Westmoreland Matthews Bruce 001623 Bruce A. Matthews, D.M.D., M.D.S. 1225 S. Main Street, Wellington Square, #300 Greensburg PA 15601 Orthodontist Westmoreland * Kraisinger Paul 001667 Complete Family Dentistry 80 Huff Avenue, #1 Greensburg PA 15601 General Provider Westmoreland Haggard Kai Ying 002834 Dent-Al Smiles 29 N. Main St, Suite 206 Greensburg PA 15601 General Provider Westmoreland Adams William 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland Affolter John 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland Alagirisamy Kiruthika 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland Carozza Roselyn 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland Cohen Ira 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland Dahar Nicholas 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland Damich Louis 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland Ghaffari Catherine 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland Ghajarnia M. Reza 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland Gillen Steve 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland Iszkula Steven 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland Katsur James 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland Khurana Leena 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland Kier Calvin 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland King David 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland Kolla Siva 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland Lewis Howell 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland Miller Van 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland Pryor Leroy 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland Rinchuse Dara 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 Orthodontist Westmoreland Schmidt Alan 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland Smiga Ingrid 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland Stein Mark 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland Tinnemeyer Anjuli 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland Zalakar Frank 002227 Katsur Dental & Orthodontics 801 N Greengate Road, Suite 310 Greensburg PA 15601 General Provider Westmoreland * Indicates dentist that is accepting current patients only. All Select Plan Dentists Page 41 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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