Provider Demographics
NPI:1184778706
Name:DETWILER, ALETA LOUISE (DMD)
Entity type:Individual
Prefix:DR
First Name:ALETA
Middle Name:LOUISE
Last Name:DETWILER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1522
Mailing Address - Country:US
Mailing Address - Phone:215-536-8111
Mailing Address - Fax:215-536-1615
Practice Address - Street 1:401 WEST BROAD STREET
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951
Practice Address - Country:US
Practice Address - Phone:215-536-8111
Practice Address - Fax:215-536-1615
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020629L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice