Provider Demographics
NPI:1447506316
Name:HEARTLAND DENTAL CARE OF PENNSYLVANIA
Entity type:Organization
Organization Name:HEARTLAND DENTAL CARE OF PENNSYLVANIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5146
Mailing Address - Street 1:67 BRUMBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-2801
Mailing Address - Country:US
Mailing Address - Phone:717-263-6060
Mailing Address - Fax:
Practice Address - Street 1:67 BRUMBAUGH AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2801
Practice Address - Country:US
Practice Address - Phone:717-263-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF PENNSYLVANIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty