MEDICARE: DENTALUX, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS036923	PA

General Provider Information

NPI Number	:	1235448747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTALUX, LLC

Provider Business Mailing Address
First Line	:	1308 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3606
Country	:	US
Telephone Number	:	215-745-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3606
Country	:	US
Telephone Number	:	215-745-5100
Fax Number	:	215-745-7298

Authorized Official
Title or Position	:	OWNER/ DENTIST
Name	:	DR. JENNIFER DONSKOY
Credential	:	DDS
Telephone Number	:	215-745-5100

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	12/07/2010

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