1902357544 NPI number — WHITE FAMILY DENTAL - WILLOW STREET

Table of content: (NPI 1902357544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902357544 NPI number — WHITE FAMILY DENTAL - WILLOW STREET

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE FAMILY DENTAL - WILLOW STREET
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:
1902357544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 CONTINENTAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELIZABETHTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17022-2260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-740-2200
Provider Business Mailing Address Fax Number:
717-205-2090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 WILLOW VALLEY DRIVE
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
WILLOW STREET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-740-2200
Provider Business Practice Location Address Fax Number:
717-205-2090
Provider Enumeration Date:
10/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
717-367-1336

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS023279L , 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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