Provider Demographics
NPI:1407360639
Name:THE GENERAL DENTIST
Entity Type:Organization
Organization Name:THE GENERAL DENTIST
Other - Org Name:SARDINA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SARDINA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-898-7221
Mailing Address - Street 1:405 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17538-1812
Mailing Address - Country:US
Mailing Address - Phone:717-898-7221
Mailing Address - Fax:717-898-7357
Practice Address - Street 1:405 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDISVILLE
Practice Address - State:PA
Practice Address - Zip Code:17538-1812
Practice Address - Country:US
Practice Address - Phone:717-898-7221
Practice Address - Fax:717-898-7357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty