Provider Demographics
NPI:1083038848
Name:PENNSYLVANIA DENTAL PARTNERS SPECIALTY
Entity Type:Organization
Organization Name:PENNSYLVANIA DENTAL PARTNERS SPECIALTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUDAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-656-3051
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:330-951-9153
Mailing Address - Fax:888-817-9032
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:330-951-9153
Practice Address - Fax:888-817-9032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENNSYLVANIA DENTAL PARTNERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty