Provider Demographics
NPI:1922303874
Name:LANCASTER PEDIATRIC DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:LANCASTER PEDIATRIC DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-560-9002
Mailing Address - Street 1:1875 LITITZ PIKE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6515
Mailing Address - Country:US
Mailing Address - Phone:717-560-9002
Mailing Address - Fax:717-560-5102
Practice Address - Street 1:1875 LITITZ PIKE
Practice Address - Street 2:SUITE 9
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6515
Practice Address - Country:US
Practice Address - Phone:717-560-9002
Practice Address - Fax:717-560-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021231L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty