Provider Demographics
NPI:1558381897
Name:LANCASTER CLEFT PALATE CLINIC
Entity Type:Organization
Organization Name:LANCASTER CLEFT PALATE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:LONG
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD, MS, PHD
Authorized Official - Phone:717-394-3793
Mailing Address - Street 1:223 N LIME ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2748
Mailing Address - Country:US
Mailing Address - Phone:717-394-3793
Mailing Address - Fax:717-396-7409
Practice Address - Street 1:223 N LIME ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2748
Practice Address - Country:US
Practice Address - Phone:717-394-3793
Practice Address - Fax:717-396-7409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS013902L1223P0700X
PADS0186111223X0400X
PADS0353661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty