Provider Demographics
NPI:1124322326
Name:EPHRATA FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:EPHRATA FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DEVER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-733-7971
Mailing Address - Street 1:815 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1642
Mailing Address - Country:US
Mailing Address - Phone:717-733-7971
Mailing Address - Fax:717-738-4162
Practice Address - Street 1:815 MARTIN AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1642
Practice Address - Country:US
Practice Address - Phone:717-733-7971
Practice Address - Fax:717-738-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-02
Last Update Date:2011-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027756L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty