=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588240048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALIGNED DENTAL OF HAMBURG PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2021
-----------------------------------------------------
Last Update Date | 03/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 443 STATE ST
-----------------------------------------------------
City | HAMBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19526-1203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-562-7615
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 W CHESTNUT ST STE 205
-----------------------------------------------------
City | EPHRATA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17522-1987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGIONAL MANAGER
-----------------------------------------------------
Name | ASHLEY MCTYIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 484-888-9322
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 292200000X
-----------------------------------------------------
Taxonomy Name | Dental Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------