Healthcare Provider Details

I. General information

NPI: 1679610992
Provider Name (Legal Business Name): KEVIN G SCHWARTZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S LINCOLN AVE RM 535
LEBANON PA
17042-7529
US

IV. Provider business mailing address

7705 BRINK RD
LAYTONSVILLE MD
20882-1619
US

V. Phone/Fax

Practice location:
  • Phone: 717-272-6621
  • Fax: 717-228-6115
Mailing address:
  • Phone: 301-938-8280
  • Fax: 301-208-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401008451
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: