Provider Demographics
NPI:1861115735
Name:PROGRESSIVE DENTAL CONCEPTS LLC
Entity type:Organization
Organization Name:PROGRESSIVE DENTAL CONCEPTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CENTRALIZED SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NAILOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-798-8660
Mailing Address - Street 1:173 S 32ND ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-5102
Mailing Address - Country:US
Mailing Address - Phone:717-798-8660
Mailing Address - Fax:
Practice Address - Street 1:210 FORGE RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17007-9787
Practice Address - Country:US
Practice Address - Phone:717-258-3858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty