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General NPI Number Information
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NPI Number | 1023788494
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Entity Type | Organization
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Legal Business Name | FACIAL 32 LLC
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Dates
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Enumeration Date | 09/17/2021
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Last Update Date | 09/17/2021
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Provider Practice Location Address
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Address Line | 1191 EICHELBERGER ST
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City | HANOVER
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State | PA
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Zip | 17331-1365
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Country | US
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Telephone | 443-257-7014
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 YOUNGS RD
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City | HANOVER
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State | PA
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Zip | 17331-9451
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Country | US
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Telephone | 443-257-7014
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED MEMBER
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Name | DR. DIANA EUGENIA SHOE
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Credential | DDS
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Telephone | 443-257-7014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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