Provider Demographics
NPI:1457183014
Name:INNOVATIVEDENTALOFSHIP DAVIS FAMILY DENTISTRY
Entity type:Organization
Organization Name:INNOVATIVEDENTALOFSHIP DAVIS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-263-3123
Mailing Address - Street 1:420 E ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-2140
Mailing Address - Country:US
Mailing Address - Phone:717-532-4513
Mailing Address - Fax:
Practice Address - Street 1:420 E ORANGE ST
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-2140
Practice Address - Country:US
Practice Address - Phone:717-532-4513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty