1841512514 NPI number — DR. WENDELL T. BREITHAUPT JR. DMD

Table of content: DR. WENDELL T. BREITHAUPT JR. DMD (NPI 1841512514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841512514 NPI number — DR. WENDELL T. BREITHAUPT JR. DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BREITHAUPT
Provider First Name:
WENDELL
Provider Middle Name:
T.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1841512514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 SOUTH MAIN STREET
Provider Second Line Business Mailing Address:
DENTAL HEALTH ASSOCIATES
Provider Business Mailing Address City Name:
PHILLIPSBURG
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-454-9800
Provider Business Mailing Address Fax Number:
908-387-8322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
DENTAL HEALTH ASSOCIATES
Provider Business Practice Location Address City Name:
PHILLIPSBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-454-9800
Provider Business Practice Location Address Fax Number:
908-387-8322
Provider Enumeration Date:
02/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DI16167 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com