Provider Demographics
NPI:1215253539
Name:M.H. KAYE PAVILION INC.
Entity type:Organization
Organization Name:M.H. KAYE PAVILION INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-394-7218
Mailing Address - Street 1:1763 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4530
Mailing Address - Country:US
Mailing Address - Phone:717-394-7218
Mailing Address - Fax:717-394-7780
Practice Address - Street 1:1763 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4530
Practice Address - Country:US
Practice Address - Phone:717-394-7218
Practice Address - Fax:717-394-7780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021813R1223G0001X
PADS019067L1223G0001X
PADS020864L1223G0001X
PADS02716L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty