Provider Demographics
NPI:1003131731
Name:PHILIP J. PANDOLFI, DMD, PLLC
Entity Type:Organization
Organization Name:PHILIP J. PANDOLFI, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANDOLFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1540-433-1751
Mailing Address - Street 1:2105 EVELYN BYRD AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-5431
Mailing Address - Country:US
Mailing Address - Phone:540-433-1751
Mailing Address - Fax:540-433-1756
Practice Address - Street 1:2105 EVELYN BYRD AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-5431
Practice Address - Country:US
Practice Address - Phone:540-433-1751
Practice Address - Fax:540-433-1756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty