Provider Demographics
NPI:1386864544
Name:CORNERSTONE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CORNERSTONE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-794-5994
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:17214-0621
Mailing Address - Country:US
Mailing Address - Phone:717-794-5994
Mailing Address - Fax:717-794-5458
Practice Address - Street 1:14989 BUCHANAN TRAIL EAST
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:17214
Practice Address - Country:US
Practice Address - Phone:717-794-5994
Practice Address - Fax:717-794-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-028207-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty