MEDICARE: JOHN DOUGLAS ORMSBY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS025768L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	434076	OTHER	PA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1295829158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DOUGLAS ORMSBY DMD

Provider Business Mailing Address
First Line	:	4752 SR 655
Second Line	:	SUITE C
City	:	BELLEVILLE
State	:	PA
Zip	:	17004
Country	:	US
Telephone Number	:	717-935-2295
Fax Number	:	717-935-5095

Provider Business Practice Location Address
First Line	:	4752 SR 655
Second Line	:	SUITE C
City	:	BELLEVILLE
State	:	PA
Zip	:	17004
Country	:	US
Telephone Number	:	717-935-2295
Fax Number	:	717-935-5095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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