Provider Demographics
NPI:1437466208
Name:HARELYSVILLE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:HARELYSVILLE FAMILY DENTISTRY
Other - Org Name:TOWAMENCIN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SULZBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-362-8166
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:1111 FORTY FOOT ROAD
Mailing Address - City:KULPSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19443
Mailing Address - Country:US
Mailing Address - Phone:215-362-8166
Mailing Address - Fax:215-368-4235
Practice Address - Street 1:1111 FORTY FOOT ROAD
Practice Address - Street 2:
Practice Address - City:KULPSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19443-0220
Practice Address - Country:US
Practice Address - Phone:215-362-8166
Practice Address - Fax:215-368-4235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0377561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty