Provider Demographics
NPI:1073770269
Name:CUMBERLAND VALLEY DENTAL CARE
Entity Type:Organization
Organization Name:CUMBERLAND VALLEY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-263-3123
Mailing Address - Street 1:99 ST PAUL DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1020
Mailing Address - Country:US
Mailing Address - Phone:717-263-3123
Mailing Address - Fax:717-264-4346
Practice Address - Street 1:99 SAINT PAULS DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1020
Practice Address - Country:US
Practice Address - Phone:717-263-3123
Practice Address - Fax:717-264-4346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019846L122300000X
PADS017994L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty