Healthcare Provider Details

I. General information

NPI: 1295829158
Provider Name (Legal Business Name): JOHN DOUGLAS ORMSBY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: J DOUGLAS ORMSBY DMD

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4752 SR 655 SUITE C
BELLEVILLE PA
17004
US

IV. Provider business mailing address

4752 SR 655 SUITE C
BELLEVILLE PA
17004
US

V. Phone/Fax

Practice location:
  • Phone: 717-935-2295
  • Fax: 717-935-5095
Mailing address:
  • Phone: 717-935-2295
  • Fax: 717-935-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS025768L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: