Provider Demographics
NPI:1720115462
Name:COLONIAL DENTAL GROUP PC
Entity Type:Organization
Organization Name:COLONIAL DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAJJAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-901-7045
Mailing Address - Street 1:4940 LINGLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-9515
Mailing Address - Country:US
Mailing Address - Phone:717-901-7045
Mailing Address - Fax:717-901-7050
Practice Address - Street 1:4940 LINGLESTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-9515
Practice Address - Country:US
Practice Address - Phone:717-901-7045
Practice Address - Fax:717-901-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-014034-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty