1235566175 NPI number — HARELYSVILLE FAMILY DENTISTRY LLC

Table of content: (NPI 1235566175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235566175 NPI number — HARELYSVILLE FAMILY DENTISTRY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARELYSVILLE 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:
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:
1235566175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 COMMERCE DR
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
FT WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19034-2714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-550-7186
Provider Business Mailing Address Fax Number:
215-646-6166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
456 SCHOOL LN
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
HARLEYSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19438-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-867-4561
Provider Business Practice Location Address Fax Number:
215-646-6166
Provider Enumeration Date:
10/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZ
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
PROFESSIONAL DEVELOPMENT EXEC.
Authorized Official Telephone Number:
215-550-7185

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DS037756 , 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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