Provider Demographics
NPI:1891032629
Name:PENNSYLVANIA DENTAL PARTNERS, LLC
Entity type:Organization
Organization Name:PENNSYLVANIA DENTAL PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUDAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-519-0100
Mailing Address - Street 1:120 N POINTE BLVD
Mailing Address - Street 2:STE.300
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4100
Mailing Address - Country:US
Mailing Address - Phone:717-519-0100
Mailing Address - Fax:717-569-8063
Practice Address - Street 1:355 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-2107
Practice Address - Country:US
Practice Address - Phone:717-656-3051
Practice Address - Fax:717-656-6205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLACKFORD DENTAL MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026808L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty