# PAXTANG FAMILY DENTISTRY INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639446057
- **Authorized official:** DR. JILL RACHAEL CARRE DMD (OWNER)
- **Authorized official phone:** (717) 561-1209

## Contact information

- **Practice address:** 3404 DERRY ST, SUITE 1, HARRISBURG, PA 17111-1834
- **Practice address phone:** (717) 561-1209
- **Practice address fax:** (717) 561-4033
- **Mailing address:** 3404 DERRY ST, SUITE 1, HARRISBURG, PA 17111-1834
- **Mailing address phone:** (717) 561-1209
- **Mailing address fax:** (717) 561-4033

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DS035741 | PA | Yes |

## Other

- **Enumeration date:** 11/30/2011
- **Last updated:** 11/30/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1024184100001 | — | PA |