Paul J Prosser III, DDS
Individual provider Active NPI General Practice Dentistry · New Freedom, PA
NPI 1023194875 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1023194875
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DS025652L (PA)
- Practice address
- 781 Far Hills Dr
Suite 500
New Freedom, PA 17349-8447 - Phone
- (717) 235-8234
- Fax
- (717) 235-8266
- NPI assigned
- Oct 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS025652L | PA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stonebridge Dental LLC | General Practice | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS025652L | PA | Yes |
Addresses
Primary practice location
781 Far Hills Dr
Suite 500
New Freedom, PA 17349-8447
Mailing address
4855 Carea Rd
White Hall, MD 21161-8960
Phone (410) 692-9474
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- Mary Collette Parks
- Douglas H Prince
- Caitlin Quinton
- Michelle Rabinovich
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- Jean Elaine Rudisill
All providers in New Freedom, PA · General Practice Dentistry in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.