Provider Demographics
NPI:1003228289
Name:PENNSYLVANIA DENTAL PARTNERS SPECIALITY
Entity Type:Organization
Organization Name:PENNSYLVANIA DENTAL PARTNERS SPECIALITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-283-1990
Mailing Address - Street 1:600A EDEN RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4205
Mailing Address - Country:US
Mailing Address - Phone:717-283-1990
Mailing Address - Fax:
Practice Address - Street 1:600A EDEN RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4205
Practice Address - Country:US
Practice Address - Phone:717-283-1990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENNSYLVANIA DENTAL PARTNERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty