1508921644 NPI number — RICHBORO FAMILY DENTISTRY LLC

Table of content: (NPI 1508921644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508921644 NPI number — RICHBORO FAMILY DENTISTRY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHBORO FAMILY DENTISTRY LLC
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:
DR GLENN MILLER AND DR DONALD TEDROW
Provider Other Organization Name Type Code:
5
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:
1508921644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 ALMSHOUSE ROAD
Provider Second Line Business Mailing Address:
SUITE NUMBER 500
Provider Business Mailing Address City Name:
RICHBORO
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-322-0440
Provider Business Mailing Address Fax Number:
215-322-3941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 ALMSHOUSE ROAD
Provider Second Line Business Practice Location Address:
SUITE NUMBER 500
Provider Business Practice Location Address City Name:
RICHBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-322-0440
Provider Business Practice Location Address Fax Number:
215-322-3941
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TEDROW
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER PARTNER
Authorized Official Telephone Number:
215-322-0440

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS023139L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: DS022913L , registered in the state of PA ; 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