Healthcare Provider Details

I. General information

NPI: 1669965521
Provider Name (Legal Business Name): CDH ORTHODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 CRUMS MILL RD STE 2
HARRISBURG PA
17112-2898
US

IV. Provider business mailing address

200 WILLOWBROOK LN STE 220
WEST CHESTER PA
19382-5697
US

V. Phone/Fax

Practice location:
  • Phone: 717-295-4400
  • Fax: 717-540-1420
Mailing address:
  • Phone: 610-500-2042
  • Fax: 610-884-6296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TRISH HOWER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 302-500-2042