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General NPI Number Information
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NPI Number | 1003228289
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Entity Type | Organization
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Legal Business Name | PENNSYLVANIA DENTAL PARTNERS SPECIALITY
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 600A EDEN RD
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City | LANCASTER
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State | PA
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Zip | 17601-4205
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Country | US
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Telephone | 717-283-1990
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Fax |
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Provider Business Mailing Address
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Address Line | 600A EDEN RD
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City | LANCASTER
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State | PA
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Zip | 17601-4205
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Country | US
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Telephone | 717-283-1990
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. SCOTT CREWS
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Credential |
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Telephone | 717-283-1990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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