Provider Demographics
NPI:1487931143
Name:DENTAL PROFESSIONALS OF PENNSYLVANIA P C
Entity type:Organization
Organization Name:DENTAL PROFESSIONALS OF PENNSYLVANIA P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDIEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:32 NORTHEAST DR STE 202
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2758
Mailing Address - Country:US
Mailing Address - Phone:717-533-2800
Mailing Address - Fax:717-533-8200
Practice Address - Street 1:32 NORTHEAST DR STE 202
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2758
Practice Address - Country:US
Practice Address - Phone:717-533-2800
Practice Address - Fax:717-533-8200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF PENNSYLVANIA P C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty