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General NPI Number Information
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NPI Number | 1619598067
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Entity Type | Organization
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Legal Business Name | ANZUR PERIODONTICS P.C.
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Dates
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Enumeration Date | 04/27/2020
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Last Update Date | 04/27/2020
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Provider Practice Location Address
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Address Line | 4225 TRINDLE RD
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City | CAMP HILL
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State | PA
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Zip | 17011-5752
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Country | US
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Telephone | 717-763-7971
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Fax |
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Provider Business Mailing Address
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Address Line | 4225 TRINDLE RD
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City | CAMP HILL
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State | PA
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Zip | 17011-5752
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Country | US
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Telephone | 717-763-7971
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRAIG M. ANZUR
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Credential | DMD
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Telephone | 717-763-7971
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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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