Organization
DAVID A EICHENLAUB & GARY R BODMER, PARTNERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAVONNE KAY KIRKLAND (OFFICE MANAGER)
(717) 248-4896
Entity
Organization
Contact information
Practice address
744 VALLEY ST, LEWISTOWN, PA 17044-1425
(717) 248-4896
Mailing address
744 VALLEY ST, LEWISTOWN, PA 17044-1425
(717) 248-4896
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DS017307L
PA
261QD0000X
Dental Clinic/Center
DS021903L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235293341
GENERAL DENTISTRY
PA
01
—
1811051923
GENERAL DENTISTRY
PA
Enumeration date
12/12/2017
Last updated
06/16/2018
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