Healthcare Provider Details

I. General information

NPI: 1225227192
Provider Name (Legal Business Name): DENTAL ART IMAGES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W PENN AVE SUITE 213
CLEONA PA
17042
US

IV. Provider business mailing address

221 W PENN AVE SUITE 213
CLEONA PA
17042
US

V. Phone/Fax

Practice location:
  • Phone: 717-272-8500
  • Fax: 717-272-6101
Mailing address:
  • Phone: 717-272-8500
  • Fax: 717-272-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS035405
License Number StatePA

VIII. Authorized Official

Name: JENNIFER S DAVIS
Title or Position: OWNER
Credential: DMD
Phone: 717-272-8500