MEDICARE: DR. PHILIP FRANK MADDALONI DDS

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	DS017931L	PA

General Provider Information

NPI Number	:	1417075953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP FRANK MADDALONI DDS

Provider Business Mailing Address
First Line	:	1325 EAST HIGH ST
Second Line	:
City	:	POTTSTOWN
State	:	PA
Zip	:	19464-4949
Country	:	US
Telephone Number	:	610-326-0285
Fax Number	:	610-326-0285

Provider Business Practice Location Address
First Line	:	1325 EAST HIGH ST
Second Line	:
City	:	POTTSTOWN
State	:	PA
Zip	:	19464-4949
Country	:	US
Telephone Number	:	610-326-0285
Fax Number	:	610-326-0285

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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