1619322708 NPI number — HERSHEY DENTAL ASSOCIATES LLC

Table of content: (NPI 1619322708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619322708 NPI number — HERSHEY DENTAL ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERSHEY DENTAL ASSOCIATES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BUEHNER FAMILY DENTAL CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619322708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
517 SUNBURY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINERSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17954-1015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-544-4446
Provider Business Mailing Address Fax Number:
570-544-5224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
517 SUNBURY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17954-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-544-4446
Provider Business Practice Location Address Fax Number:
570-544-5224
Provider Enumeration Date:
04/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BUEHNER
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/DENTIST
Authorized Official Telephone Number:
717-220-1792

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS036596 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com