Provider Demographics
NPI:1154431245
Name:CLEVELAND L. NULL, DDS, PC
Entity type:Organization
Organization Name:CLEVELAND L. NULL, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLEVELAND
Authorized Official - Middle Name:L
Authorized Official - Last Name:NULL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-334-8193
Mailing Address - Street 1:353 YORK ST
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-1931
Mailing Address - Country:US
Mailing Address - Phone:717-334-8193
Mailing Address - Fax:717-334-8432
Practice Address - Street 1:353 YORK ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-1931
Practice Address - Country:US
Practice Address - Phone:717-334-8193
Practice Address - Fax:717-334-8432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-020984L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental