Provider Demographics
NPI:1902150923
Name:HEARTLAND DENTAL CARE OF PA
Entity Type:Organization
Organization Name:HEARTLAND DENTAL CARE OF PA
Other - Org Name:CENTER STREET FAMILY DENTISTRY
Other - Org Type:Doing Business As
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 1:1865 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1703
Mailing Address - Country:US
Mailing Address - Phone:717-761-0414
Mailing Address - Fax:
Practice Address - Street 1:1865 CENTER ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1703
Practice Address - Country:US
Practice Address - Phone:717-761-0414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty