Provider Demographics
NPI:1174698914
Name:SHREWSBURY FAMILY DENTISTRY B
Entity type:Organization
Organization Name:SHREWSBURY FAMILY DENTISTRY B
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FABIO
Authorized Official - Middle Name:C
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-235-8151
Mailing Address - Street 1:73 E FORREST AVE
Mailing Address - Street 2:SHREWSBURY FAMILY DENTISTRY B
Mailing Address - City:SHREWSBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17361-1400
Mailing Address - Country:US
Mailing Address - Phone:717-235-8151
Mailing Address - Fax:717-235-6741
Practice Address - Street 1:73 E FORREST AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1400
Practice Address - Country:US
Practice Address - Phone:717-235-8151
Practice Address - Fax:717-235-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028573L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty