Provider Demographics
NPI:1689180556
Name:SULTZBAUGH, CHASITY (RDH)
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:
Last Name:SULTZBAUGH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:986 PONDTOWN RD
Mailing Address - Street 2:
Mailing Address - City:DILLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17019-9209
Mailing Address - Country:US
Mailing Address - Phone:717-779-8837
Mailing Address - Fax:
Practice Address - Street 1:986 PONDTOWN RD
Practice Address - Street 2:
Practice Address - City:DILLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17019-9209
Practice Address - Country:US
Practice Address - Phone:717-779-8837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH067571124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist