Healthcare Provider Details

I. General information

NPI: 1538376926
Provider Name (Legal Business Name): CENTRAL PENN ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4661 TRINDLE RD
CAMP HILL PA
17011-5603
US

IV. Provider business mailing address

4661 TRINDLE RD
CAMP HILL PA
17011-5603
US

V. Phone/Fax

Practice location:
  • Phone: 717-737-4588
  • Fax: 717-737-7910
Mailing address:
  • Phone: 717-737-4588
  • Fax: 717-737-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS030789L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS027163L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JASON P. DEVEY
Title or Position: PRESIDENT
Credential: DMD
Phone: 717-737-4588