1821591025 NPI number — VERBER DENTAL GROUP, PC

Table of content: (NPI 1821591025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821591025 NPI number — VERBER DENTAL GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERBER DENTAL GROUP, 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:
Provider Other Organization Name Type Code:
6
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:
1821591025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
819 MARKET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEMOYNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17043-1588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-761-0341
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
819 MARKET STREET
Provider Second Line Business Practice Location Address:
FOX DENTAL
Provider Business Practice Location Address City Name:
LEMOYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-761-0341
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ASCHLIMAN
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
TREATMENT COORDINATOR
Authorized Official Telephone Number:
717-737-4337

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 792170001 . This is a "DMERC REGION A" identifier , issued by the state of ( PW ) . This identifiers is of the category "OTHER".
  • Identifier: 003805309 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".