Provider Demographics
NPI:1487034005
Name:PENNSYLVANIA DENTAL SPECIALTY GROUP, PC
Entity Type:Organization
Organization Name:PENNSYLVANIA DENTAL SPECIALTY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-590-1513
Mailing Address - Street 1:101 N POINTE BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4108
Mailing Address - Country:US
Mailing Address - Phone:717-590-1513
Mailing Address - Fax:484-731-9015
Practice Address - Street 1:101 N POINTE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4108
Practice Address - Country:US
Practice Address - Phone:717-590-1513
Practice Address - Fax:484-731-9015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty