1639380033 NPI number — JOSEPH J HAVRILLA DDS INC

Table of content: (NPI 1639380033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639380033 NPI number — JOSEPH J HAVRILLA DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH J HAVRILLA DDS 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:
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:
1639380033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 W SPROUL RD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19064-1254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-328-9608
Provider Business Mailing Address Fax Number:
610-328-5549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2004 SPROUL RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
BROOMALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-328-9608
Provider Business Practice Location Address Fax Number:
610-328-5549
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAVRILLA
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-328-9608

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X , with the licence number:  DS024390-L , 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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