Provider Demographics
NPI:1184632473
Name:HOSTETLER FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:HOSTETLER FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HOSTETLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:724-438-7676
Mailing Address - Street 1:665 CHERRY TREE LN
Mailing Address - Street 2:#B
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8947
Mailing Address - Country:US
Mailing Address - Phone:724-438-7676
Mailing Address - Fax:724-438-3060
Practice Address - Street 1:665 CHERRY TREE LN
Practice Address - Street 2:#B
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8947
Practice Address - Country:US
Practice Address - Phone:724-438-7676
Practice Address - Fax:724-438-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030210L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA030210OtherDELTA
PA963585OtherBCBS
PA0018764910001Medicaid