Provider Demographics
NPI:1003436924
Name:JACK D. STEELE, D.M.D., FAMILY DENTISTRY, L.L.C.
Entity Type:Organization
Organization Name:JACK D. STEELE, D.M.D., FAMILY DENTISTRY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:D
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-485-3015
Mailing Address - Street 1:501 E POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:MC CONNELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17233-1151
Mailing Address - Country:US
Mailing Address - Phone:717-485-3015
Mailing Address - Fax:717-485-3096
Practice Address - Street 1:501 E POPLAR ST
Practice Address - Street 2:
Practice Address - City:MC CONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233-1151
Practice Address - Country:US
Practice Address - Phone:717-485-3015
Practice Address - Fax:717-485-3096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018617750004Medicaid
PA0018617750006Medicaid
PA1037711320001Medicaid