Provider Demographics
NPI:1962531525
Name:FETTEROLF, DANA MICHELLE (DMD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MICHELLE
Last Name:FETTEROLF
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MICHELLE
Other - Last Name:HARMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4400 DEER PATH RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3908
Mailing Address - Country:US
Mailing Address - Phone:717-233-7718
Mailing Address - Fax:717-233-7729
Practice Address - Street 1:4400 DEER PATH RD
Practice Address - Street 2:SUITE 104
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3908
Practice Address - Country:US
Practice Address - Phone:717-233-7718
Practice Address - Fax:717-233-7729
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030254L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice