Provider Demographics
NPI:1124054176
Name:HENTELEFF, HARVEY BARNARD (DMD)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:BARNARD
Last Name:HENTELEFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CAMBRIA AVE
Mailing Address - Street 2:
Mailing Address - City:AVONMORE
Mailing Address - State:PA
Mailing Address - Zip Code:15618
Mailing Address - Country:US
Mailing Address - Phone:724-697-4483
Mailing Address - Fax:724-697-4485
Practice Address - Street 1:600 CAMBRIA AVE
Practice Address - Street 2:
Practice Address - City:AVONMORE
Practice Address - State:PA
Practice Address - Zip Code:15618-9791
Practice Address - Country:US
Practice Address - Phone:724-697-4483
Practice Address - Fax:724-697-4485
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020937L1223G0001X
PADAO20937A1223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology
No1223G0001XDental ProvidersDentistGeneral Practice