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General NPI Number Information
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NPI Number | 1538585740
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Entity Type | Individual
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Provider Name | KRISTOPHER DOERSAM DDS
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Gender | Female
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 2687 EUCLID AVE
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City | S WILLIAMSPORT
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State | PA
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Zip | 17702-6754
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Country | US
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Telephone | 570-326-5456
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Fax | 570-323-4550
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Provider Business Mailing Address
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Address Line | 401 N WASHINGTON ST
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City | MONTOURSVILLE
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State | PA
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Zip | 17754-1337
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Country | US
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Telephone | 570-326-5456
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Fax | 570-323-4550
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS037538
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License Number State | PA
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