1083038848 NPI number — PENNSYLVANIA DENTAL PARTNERS SPECIALTY

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 1083038848 NPI number — PENNSYLVANIA DENTAL PARTNERS SPECIALTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENNSYLVANIA DENTAL PARTNERS SPECIALTY
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:
Provider Other Organization Name Type Code:
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:
1083038848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600A EDEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17601-4205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-951-9153
Provider Business Mailing Address Fax Number:
888-817-9032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600A EDEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17601-4205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-951-9153
Provider Business Practice Location Address Fax Number:
888-817-9032
Provider Enumeration Date:
02/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DUDAS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDEN
Authorized Official Telephone Number:
717-656-3051

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X , 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)





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