Provider Demographics
NPI:1053960054
Name:PROGRESSIVE DENTAL CONCEPTS, LLC
Entity type:Organization
Organization Name:PROGRESSIVE DENTAL CONCEPTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-580-3603
Mailing Address - Street 1:173 S 32ND ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-5102
Mailing Address - Country:US
Mailing Address - Phone:717-891-0651
Mailing Address - Fax:
Practice Address - Street 1:4004 TRINDLE RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4242
Practice Address - Country:US
Practice Address - Phone:717-737-5120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty