1710004155 NPI number — WBG DENTISTRY INC

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 1710004155 NPI number — WBG DENTISTRY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WBG DENTISTRY INC
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:
WINAH B GALLAGHER DMD FAMILY DENTISTRY
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:
1710004155
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:
920 LAWN AVE STE E1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELLERSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18960-1560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-453-6630
Provider Business Mailing Address Fax Number:
215-453-6909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 LAWN AVE STE E1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELLERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18960-1560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-453-6630
Provider Business Practice Location Address Fax Number:
215-453-6909
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
ISABELLA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
215-453-6630

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DX001157L , 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)





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