Provider Demographics
NPI:1972089993
Name:STUDENT HEALTH IMPACT PROJECT
Entity type:Organization
Organization Name:STUDENT HEALTH IMPACT PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BICKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-916-6447
Mailing Address - Street 1:6097 EASTON RD
Mailing Address - Street 2:
Mailing Address - City:PIPERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18947-1810
Mailing Address - Country:US
Mailing Address - Phone:866-916-6447
Mailing Address - Fax:267-927-5007
Practice Address - Street 1:6097 EASTON RD
Practice Address - Street 2:
Practice Address - City:PIPERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18947-1810
Practice Address - Country:US
Practice Address - Phone:866-916-6447
Practice Address - Fax:267-927-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty