1396388427 NPI number — ALIGNED DENTAL OF EAST PETERSBURG

Table of content: (NPI 1396388427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396388427 NPI number — ALIGNED DENTAL OF EAST PETERSBURG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALIGNED DENTAL OF EAST PETERSBURG
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:
1396388427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 W CHESTNUT ST STE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EPHRATA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17522-1987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-372-8406
Provider Business Mailing Address Fax Number:
610-372-3998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1882 ROHRERSTOWN 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:
17601-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-569-0454
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GROVE
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
N.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-372-8406

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)

  • Identifier: 1477565232 . This is a "NPI" identifier . This identifiers is of the category "OTHER".