1649676206 NPI number — DENTAL HEALTH AND HEALING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649676206 NPI number — DENTAL HEALTH AND HEALING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL HEALTH AND HEALING
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:
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:
1649676206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 HILLENDALE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVONDALE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19311-9742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-647-2755
Provider Business Mailing Address Fax Number:
610-444-5607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 HILLENDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVONDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19311-9742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-647-2755
Provider Business Practice Location Address Fax Number:
610-444-5607
Provider Enumeration Date:
11/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MOSER
Authorized Official First Name:
GALE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CORPORATE VICE PRESIDENT
Authorized Official Telephone Number:
610-647-2755

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  DS018325L , 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)

  • Identifier: DS018325L . This is a "STATE DENTAL LICENSE NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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