1053772442 NPI number — DENTAL PROFESSIONALS OF PENNSYLVANIA, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053772442 NPI number — DENTAL PROFESSIONALS OF PENNSYLVANIA, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL PROFESSIONALS OF PENNSYLVANIA, PC
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:
DENTAL CARE OF HARRISBURG
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:
1053772442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2323 LINGLESTOWN ROAD
Provider Second Line Business Mailing Address:
UNIT 201A
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2323 LINGLESTOWN ROAD
Provider Second Line Business Practice Location Address:
UNIT 201A
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-839-5021
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
KENDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING TEAM LEAD
Authorized Official Telephone Number:
217-540-8312

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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