Provider Demographics
NPI:1326188061
Name:HANOVER FAMILY DENTAL GROUP, INC.
Entity Type:Organization
Organization Name:HANOVER FAMILY DENTAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-326-4448
Mailing Address - Street 1:1885 SWAMP PIKE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-9666
Mailing Address - Country:US
Mailing Address - Phone:610-326-4448
Mailing Address - Fax:610-326-9414
Practice Address - Street 1:1885 SWAMP PIKE
Practice Address - Street 2:SUITE 110
Practice Address - City:GILBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19525-9666
Practice Address - Country:US
Practice Address - Phone:610-326-4448
Practice Address - Fax:610-326-9414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty