Provider Demographics
NPI:1093928301
Name:CENTERVILLE FAMILY DENTAL
Entity Type:Organization
Organization Name:CENTERVILLE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:H
Authorized Official - Last Name:STRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-898-9099
Mailing Address - Street 1:803 ESTELLE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2130
Mailing Address - Country:US
Mailing Address - Phone:717-898-9099
Mailing Address - Fax:717-898-8665
Practice Address - Street 1:803 ESTELLE DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2130
Practice Address - Country:US
Practice Address - Phone:717-898-9099
Practice Address - Fax:717-898-8665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026681L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty