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Provider Information for 1528198918

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: MALE

Individual NPI: 1528198918

Calendar   Last Updated:  2018-10-22
  Certification Date: 


Name Value
NPI 1528198918
Enumeration Date 2007-03-06
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 1065 CHAPEL FORGE DR
LANCASTER, PA 17601-1756
United States

Phone: 717-898-6680 | Fax:
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Primary Practice Address 650 W BALTIMORE ST
BALTIMORE, MD 21201-1510
United States

Phone: 410-706-7101 | Fax:
View Map External Link
Secondary Practice Address 816 ESTELLE DR STE 1
LANCASTER, PA 17601-2135
United States

Phone: 717-898-2228 | Fax: 717-898-3204
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Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist MD 8490
No 1223G0001X - Dentist General Practice PA DS024292L