Healthcare Provider Details

I. General information

NPI: 1548633639
Provider Name (Legal Business Name): LINDA BEAM RDH, PHDHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 CROWN AVE
LANCASTER PA
17601-6322
US

IV. Provider business mailing address

1685 CROWN AVE
LANCASTER PA
17601-6322
US

V. Phone/Fax

Practice location:
  • Phone: 717-481-7645
  • Fax:
Mailing address:
  • Phone: 717-481-7645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH006019L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: