Provider Demographics
NPI:1548588437
Name:MECHANICSBURG DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MECHANICSBURG DENTAL ASSOCIATES, LLC
Other - Org Name:PERCARPIO, KEANE & ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-697-4609
Mailing Address - Street 1:500 GETTYSBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5155
Mailing Address - Country:US
Mailing Address - Phone:717-697-4609
Mailing Address - Fax:717-691-5959
Practice Address - Street 1:500 GETTYSBURG PIKE
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-5155
Practice Address - Country:US
Practice Address - Phone:717-697-4609
Practice Address - Fax:717-691-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty