Provider Demographics
NPI:1184459125
Name:LEBANON DENT CORNWALL, LLC
Entity type:Organization
Organization Name:LEBANON DENT CORNWALL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-376-9136
Mailing Address - Street 1:1545 RITA LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-5865
Mailing Address - Country:US
Mailing Address - Phone:717-376-9136
Mailing Address - Fax:
Practice Address - Street 1:1500 CORNWALL RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7403
Practice Address - Country:US
Practice Address - Phone:717-273-0411
Practice Address - Fax:717-769-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental