Organization
PAXTANG FAMILY DENTISTRY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JILL RACHAEL CARRE DMD (OWNER)
(717) 561-1209
Entity
Organization
Contact information
Practice address
3404 DERRY ST, SUITE 1, HARRISBURG, PA 17111-1834
(717) 561-1209
(717) 561-4033
Mailing address
3404 DERRY ST, SUITE 1, HARRISBURG, PA 17111-1834
(717) 561-1209
(717) 561-4033
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS035741
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1024184100001
—
PA
Enumeration date
11/30/2011
Last updated
11/30/2011
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