Covenant Family Dental LLC

Key facts

NPI

1619643202

Entity type

Organization (NPI type 2)

Primary specialty

Dental Clinic/Center 261QD0000X

Legal business name

COVENANT FAMILY DENTAL LLC

Practice address

50 Eastern Ave Ste 108
Greencastle, PA 17225-1100

Phone

(717) 762-1515

NPI assigned

Aug 23, 2021

Organization subpart

No

Authorized official

Name

Anvarali Mohammadh, DMD NPI 1750693024

Title

Owner

Phone

(717) 762-1515

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Anvarali Mohammadh, DMD Dentist · Brookhaven, PA · NPI 1750693024
  NPD Authorized official

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

Other names

• Greencastle Family Dental Doing business as
• Grencastle Family Dental Doing business as

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 27, 2021.

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1619643202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 S POTOMAC ST",
            "city": "WAYNESBORO",
            "state": "PA",
            "postal_code": "172682198",
            "telephone_number": "717-762-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 EASTERN AVE STE 108",
            "city": "GREENCASTLE",
            "state": "PA",
            "postal_code": "172251100",
            "telephone_number": "717-762-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "MOHAMMADH",
        "authorized_official_first_name": "ANVARALI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "717-762-1515",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1038734820001",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stacey@covenantfamilydentistry.com",
            "affiliation": "N",
            "endpointDescription": "Manager",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "750 S Potomac St",
            "city": "Waynesboro",
            "state": "PA",
            "country_code": "US",
            "postal_code": "172682198",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Greencastle Family Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grencastle Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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All providers in Greencastle, PA · Dental Clinic/Center in Pennsylvania