1275220865 NPI number — BUXMONT PERIODONTICS AND DENTAL IMPLANTS PLLC

Table of content: (NPI 1275220865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275220865 NPI number — BUXMONT PERIODONTICS AND DENTAL IMPLANTS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUXMONT PERIODONTICS AND DENTAL IMPLANTS PLLC
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:
1275220865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
391 ESSEX CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERKASIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18944-1297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-307-2358
Provider Business Mailing Address Fax Number:
267-873-4077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
179 N MAIN ST UNIT 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18917-2107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-873-4044
Provider Business Practice Location Address Fax Number:
267-873-4077
Provider Enumeration Date:
04/24/2023

Additional Information

Authorized Official

Authorized Official Last Name:
MUSTAZZA
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
LEONARD
Authorized Official Title or Position:
OWNER/ PERIODONTIST
Authorized Official Telephone Number:
267-307-2358

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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