Healthcare Provider Details

I. General information

NPI: 1558381897
Provider Name (Legal Business Name): LANCASTER CLEFT PALATE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N LIME ST
LANCASTER PA
17602-2748
US

IV. Provider business mailing address

223 N LIME ST
LANCASTER PA
17602-2748
US

V. Phone/Fax

Practice location:
  • Phone: 717-394-3793
  • Fax: 717-396-7409
Mailing address:
  • Phone: 717-394-3793
  • Fax: 717-396-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS013902L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS018611
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS035366
License Number StatePA

VIII. Authorized Official

Name: DR. ROSS EUGENE LONG JR.
Title or Position: EXECUTIVE DIRECTOR
Credential: DMD, MS, PHD
Phone: 717-394-3793