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General NPI Number Information
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NPI Number | 1386864544
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Entity Type | Organization
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Legal Business Name | CORNERSTONE FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14989 BUCHANAN TRAIL EAST
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City | BLUE RIDGE SUMMIT
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State | PA
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Zip | 17214
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Country | US
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Telephone | 717-794-5994
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Fax | 717-794-5458
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Provider Business Mailing Address
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Address Line | PO BOX 621
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City | BLUE RIDGE SUMMIT
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State | PA
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Zip | 17214-0621
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Country | US
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Telephone | 717-794-5994
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Fax | 717-794-5458
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Authorized Official
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Title or Position | CO-OWNER
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Name | ROBERT ZIMMERMAN
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Credential | DDS
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Telephone | 717-794-5994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS-028207-L
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License Number State | PA
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