Organization · NPI-2

5th Avenue Dental

Dentist, General Practice · Lebanon, PA

NPI number1194115121
StatusActive
Last updated in NPPESJan 29, 2015

Details

NPI
1194115121
Entity type
Organization (NPI-2)
Legal business name
5th Avenue Dental
Organization subpart
No
Enumeration date
Jan 29, 2015
Last updated
Jan 29, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General PracticeDS019581LPAYes

Practice location

1230 S 5th Ave
Lebanon, PA 17042-7814

Phone 717-272-9552 · Fax 717-272-9545

Mailing address

1230 S 5th Ave
Lebanon, PA 17042-7814

Phone 717-272-9552 · Fax 717-272-9545

Authorized official

Gregory V Arnold
Dentist
7172729552

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