Provider Demographics
NPI:1932122140
Name:DENTAL CARE ASSOCIATES, WEST
Entity Type:Organization
Organization Name:DENTAL CARE ASSOCIATES, WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNR/PTNR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:AVES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-652-4551
Mailing Address - Street 1:2 ATRIUM CT
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-9019
Mailing Address - Country:US
Mailing Address - Phone:570-374-2424
Mailing Address - Fax:570-374-1045
Practice Address - Street 1:2 ATRIUM CT
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9019
Practice Address - Country:US
Practice Address - Phone:570-374-2424
Practice Address - Fax:570-374-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017834L122300000X, 1223S0112X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty