1740299767 NPI number — DR. BRUCE JOEL SAILOR DDS

Table of content: DR. BRUCE JOEL SAILOR DDS (NPI 1740299767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740299767 NPI number — DR. BRUCE JOEL SAILOR DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAILOR
Provider First Name:
BRUCE
Provider Middle Name:
JOEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1740299767
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 N BROAD STREET
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
LANSDALE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-855-1173
Provider Business Mailing Address Fax Number:
215-855-1936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 N BROAD STREET
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LANSDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-855-1173
Provider Business Practice Location Address Fax Number:
215-855-1936
Provider Enumeration Date:
08/07/2006

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: 1223E0200X , with the licence number:  DS017521L , 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: 054393 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113237 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5728 . This is a "PENNSYLVANIA DENTAL ASSOC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1152 . This is a "AMERICAN ASSOC OF ENDODON" identifier . This identifiers is of the category "OTHER".
  • Identifier: DS017521L . This is a "STATE LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1560 . This is a "AETNA DMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89839 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 054393 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".




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