1225368012 NPI number — DOYLESTOWN TOWNSHIP DENTAL ASSOCIATES, LLC

Table of content: (NPI 1225368012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225368012 NPI number — DOYLESTOWN TOWNSHIP DENTAL ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOYLESTOWN TOWNSHIP DENTAL ASSOCIATES, 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:
Provider Other Organization Name Type Code:
6
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:
1225368012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
812 NORTH EASTON RD.
Provider Second Line Business Mailing Address:
SUITE#8
Provider Business Mailing Address City Name:
DOYLESTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18902-1007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-348-4494
Provider Business Mailing Address Fax Number:
267-277-3467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
812 N EASTON RD
Provider Second Line Business Practice Location Address:
SUITE #8
Provider Business Practice Location Address City Name:
DOYLESTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18902-1063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-348-4494
Provider Business Practice Location Address Fax Number:
267-277-3467
Provider Enumeration Date:
12/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LUDT
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
D
Authorized Official Title or Position:
ADMINISTRATIVE ASSISTANT
Authorized Official Telephone Number:
215-348-4494

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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