1942665377 NPI number — COMPLETE DENTAL SOLUTION OF LIMERICK LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942665377 NPI number — COMPLETE DENTAL SOLUTION OF LIMERICK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE DENTAL SOLUTION OF LIMERICK 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:
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:
1942665377
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
292 W.RIDGE PIKE
Provider Second Line Business Mailing Address:
BUILDING B, 2ND FL
Provider Business Mailing Address City Name:
LIMERICK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
292 W RIDGE PIKE
Provider Second Line Business Practice Location Address:
BUILDING B, 2ND FL
Provider Business Practice Location Address City Name:
LIMERICK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19468-3716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-308-6609
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WATSON
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-308-6609

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  DS027446-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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