Healthcare Provider Details

I. General information

NPI: 1003377722
Provider Name (Legal Business Name): DR. AMRITA BHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 OREGON PIKE
LANCASTER PA
17601-6463
US

IV. Provider business mailing address

619 THORNBERRY LN APT 208
LITITZ PA
17543-8048
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-6421
  • Fax:
Mailing address:
  • Phone: 717-569-8385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS040891
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: