Provider Demographics
NPI:1609094515
Name:DETWILER, MARIANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIANNA
Middle Name:
Last Name:DETWILER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 SWEETWATER DR
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-8650
Mailing Address - Country:US
Mailing Address - Phone:717-201-2823
Mailing Address - Fax:717-657-0088
Practice Address - Street 1:4401 LINGLESTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-8557
Practice Address - Country:US
Practice Address - Phone:717-652-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist