Healthcare Provider Details

I. General information

NPI: 1407257553
Provider Name (Legal Business Name): 717DENTIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 ELM AVE
LANCASTER PA
17603-4632
US

IV. Provider business mailing address

1337 ELM AVE
LANCASTER PA
17603-4632
US

V. Phone/Fax

Practice location:
  • Phone: 717-393-7515
  • Fax: 717-393-7548
Mailing address:
  • Phone: 717-393-7515
  • Fax: 717-393-7548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS035258
License Number StatePA

VIII. Authorized Official

Name: DR. RASHI MAJITHIA
Title or Position: OWNER
Credential: DMD
Phone: 717-393-7515