MEDICARE: DR. PAUL K BOOKMAN

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	DS025569L	PA

General Provider Information

NPI Number	:	1497835664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL K BOOKMAN

Provider Business Mailing Address
First Line	:	780 W LANCASTER AVE
Second Line	:	SUITE 102
City	:	BRYN MAWR
State	:	PA
Zip	:	19010-3415
Country	:	US
Telephone Number	:	610-527-2469
Fax Number	:	610-527-1915

Provider Business Practice Location Address
First Line	:	780 W LANCASTER AVE
Second Line	:	SUITE 102
City	:	BRYN MAWR
State	:	PA
Zip	:	19010-3415
Country	:	US
Telephone Number	:	610-527-2469
Fax Number	:	610-527-1915

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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