Provider Demographics
NPI:1518236694
Name:DENTAL PROFESSIONALS OF PENNSYLVANIA P C
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF PENNSYLVANIA P C
Other - Org Name:MECHANICSBURG FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE/CREDENTAILING
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:4824 E TRINDLE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-3617
Mailing Address - Country:US
Mailing Address - Phone:717-761-8056
Mailing Address - Fax:717-975-3539
Practice Address - Street 1:4824 E TRINDLE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3617
Practice Address - Country:US
Practice Address - Phone:717-761-8056
Practice Address - Fax:717-975-3539
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF PENNSYLVANIA P C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-20
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty