Provider Demographics
NPI:1477920304
Name:TARIK JBARAH DMD LLC
Entity Type:Organization
Organization Name:TARIK JBARAH DMD LLC
Other - Org Name:DR. ZEIDERS AND DR. ANGOTTI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE STAFF
Authorized Official - Prefix:
Authorized Official - First Name:ANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-632-8571
Mailing Address - Street 1:245 BALTIMORE ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-3260
Mailing Address - Country:US
Mailing Address - Phone:717-632-0877
Mailing Address - Fax:
Practice Address - Street 1:245 BALTIMORE ST
Practice Address - Street 2:SUITE #2
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-3260
Practice Address - Country:US
Practice Address - Phone:717-632-0877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TARIK JBARAH DMD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040588261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS040588OtherDENTAL LICENSE