Healthcare Provider Details

I. General information

NPI: 1083537302
Provider Name (Legal Business Name): INNOVATIVE DENTAL OF CARLISLE; CUMBERLAND VALLEY DENTAL CARE-CARLISLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 S HANOVER ST
CARLISLE PA
17013-3919
US

IV. Provider business mailing address

559 S HANOVER ST
CARLISLE PA
17013-3919
US

V. Phone/Fax

Practice location:
  • Phone: 717-245-0808
  • Fax:
Mailing address:
  • Phone: 717-245-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN L PEIFFER
Title or Position: OFFICE MANAGER
Credential:
Phone: 717-263-3123