Provider Demographics
NPI:1275898025
Name:VANCLEAF, PHILLIP J (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:J
Last Name:VANCLEAF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-3503
Mailing Address - Country:US
Mailing Address - Phone:717-264-2011
Mailing Address - Fax:717-264-0169
Practice Address - Street 1:225 WALKER RD
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-3503
Practice Address - Country:US
Practice Address - Phone:717-264-2011
Practice Address - Fax:717-264-0169
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0391331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice