Provider Demographics
NPI:1205909405
Name:MANHEIM DENTAL PC
Entity type:Organization
Organization Name:MANHEIM DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-665-2440
Mailing Address - Street 1:51 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:MANHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:17545-2413
Mailing Address - Country:US
Mailing Address - Phone:717-665-2440
Mailing Address - Fax:717-665-0104
Practice Address - Street 1:51 MARKET SQ
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-2413
Practice Address - Country:US
Practice Address - Phone:717-665-2440
Practice Address - Fax:717-665-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031376L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty