Healthcare Provider Details

I. General information

NPI: 1053624916
Provider Name (Legal Business Name): AMERICAN FAMILY DENTAL CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 HIGHLANDS DR SUITE 190
LITITZ PA
17543-2800
US

IV. Provider business mailing address

401 COMMERCE DR SUITE 108
FORT WASHINGTON PA
19034-2714
US

V. Phone/Fax

Practice location:
  • Phone: 717-303-3051
  • Fax: 717-625-4512
Mailing address:
  • Phone: 215-550-7186
  • Fax: 215-646-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS036834
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SEAN MORIARTY
Title or Position: TREATING DENTIST
Credential: D.M.D.
Phone: 717-303-3051