Provider Demographics
NPI:1386080893
Name:INNACOLA, PETER WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:WILLIAM
Last Name:INNACOLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 LINCOLN HWY E
Mailing Address - Street 2:CARANO DENTAL GRP
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2663
Mailing Address - Country:US
Mailing Address - Phone:717-394-1067
Mailing Address - Fax:
Practice Address - Street 1:1670 LINCOLN HWY E
Practice Address - Street 2:CARANO DENTAL GRP
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2663
Practice Address - Country:US
Practice Address - Phone:717-394-1067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADS0400001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program