MEDICARE: TWIN RIVERS DENTAL

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	122300000X	Dentist		PA

General Provider Information

NPI Number	:	1538564265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWIN RIVERS DENTAL

Provider Business Mailing Address
First Line	:	431 HAINES MILL RD
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18104-5940
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2762 NAZARETH RD
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18045-2717
Country	:	US
Telephone Number	:	610-253-4227
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. MELISSA DUGAN
Credential	:
Telephone Number	:	484-809-5167

Provider Enumeration Date	:	10/23/2014
Last Update Date	:	10/23/2014

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Directions to “TWIN RIVERS DENTAL ” Practice Location

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