Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DS019241L | PA |
NPI | 1003851643 |
---|---|
Provider Name | Dr. Jere B Eshelman |
First Address | Lititz, PA 17543-2516 |
Second Address | Lititz, PA 17543-2516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 08/07/2007 |