1548415243 NPI number — ADVANCED DENTISTRY OF COLLEGEVILLE PC

Table of content: (NPI 1548415243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548415243 NPI number — ADVANCED DENTISTRY OF COLLEGEVILLE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED DENTISTRY OF COLLEGEVILLE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED DENTISTRY OF COLLEGEVILLE PC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548415243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
399 ARCOLA RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
COLLEGEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19426-3906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-489-5555
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
399 ARCOLA RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
COLLEGEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19426-3906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-489-5555
Provider Business Practice Location Address Fax Number:
610-489-5163
Provider Enumeration Date:
11/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SILVA
Authorized Official First Name:
EME NELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
610-489-5555

Provider Taxonomy Codes

  • Taxonomy code: 1223D0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223E0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 124Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 305S00000X , with the licence number: DS036175 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: DS036175 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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