Provider Demographics
NPI:1154976991
Name:ADVANCED PEDIATRIC DENTISTRY LLC
Entity type:Organization
Organization Name:ADVANCED PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-679-5437
Mailing Address - Street 1:220 CUMBERLAND PKWY STE 6&7
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5683
Mailing Address - Country:US
Mailing Address - Phone:717-697-5437
Mailing Address - Fax:717-697-5437
Practice Address - Street 1:220 CUMBERLAND PKWY STE 6&7
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-5683
Practice Address - Country:US
Practice Address - Phone:717-697-5437
Practice Address - Fax:717-697-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty