Provider Demographics
NPI:1457151235
Name:CDG HARRISBURG LLC
Entity type:Organization
Organization Name:CDG HARRISBURG LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HIREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANSURIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-546-0876
Mailing Address - Street 1:6315 GREAT OAK DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-7308
Mailing Address - Country:US
Mailing Address - Phone:201-546-0876
Mailing Address - Fax:
Practice Address - Street 1:4940 LINGLESTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-9178
Practice Address - Country:US
Practice Address - Phone:717-901-7045
Practice Address - Fax:717-657-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty