Provider Demographics
NPI:1467966713
Name:KEYSTONE DENTAL PARTNERS LLC
Entity Type:Organization
Organization Name:KEYSTONE DENTAL PARTNERS LLC
Other - Org Name:RED LION DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:202-213-1544
Mailing Address - Street 1:411 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-2412
Mailing Address - Country:US
Mailing Address - Phone:717-246-1085
Mailing Address - Fax:
Practice Address - Street 1:411 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-2412
Practice Address - Country:US
Practice Address - Phone:717-246-1085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-24
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0409261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty