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Organization
ULTRA DENTAL I, LLC
Active
Organization
ULTRA DENTAL I, LLC
Active
Other names
Ultra Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHEILA ANN GPHN EFDA (EFDA/)
(717) 741-5707
Entity
Organization
Contact information
Practice address
233 PAULINE DRIVE, YORK, PA 17402
(717) 741-5707
(717) 741-5505
Mailing address
233 PAULINE DRIVE, YORK, PA 17402
(717) 741-5707
(717) 741-5505
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS024334L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102032866001
PROMISE ID
PA
05
—
1020328750
—
PA
Enumeration date
10/26/2015
Last updated
10/26/2015
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