Provider Demographics
NPI:1235376393
Name:LEOLA DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:LEOLA DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-367-1336
Mailing Address - Street 1:912 W MAIN ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-9202
Mailing Address - Country:US
Mailing Address - Phone:717-656-0005
Mailing Address - Fax:717-656-2406
Practice Address - Street 1:912 W MAIN ST
Practice Address - Street 2:SUITE 404
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-9202
Practice Address - Country:US
Practice Address - Phone:717-656-0005
Practice Address - Fax:717-656-2406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty