MEDICARE: PREVENTADENT ASSOCIATES

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

General Provider Information

NPI Number	:	1669541249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVENTADENT ASSOCIATES

Provider Business Mailing Address
First Line	:	602 S BETHLEHEM PIKE
Second Line	:	BUILDING A-1
City	:	AMBLER
State	:	PA
Zip	:	19002-5800
Country	:	US
Telephone Number	:	215-646-1665
Fax Number	:	215-646-2991

Provider Business Practice Location Address
First Line	:	602 S BETHLEHEM PIKE
Second Line	:	BUILDING A-1
City	:	AMBLER
State	:	PA
Zip	:	19002-5800
Country	:	US
Telephone Number	:	215-646-1665
Fax Number	:	215-646-2991

Authorized Official
Title or Position	:	PARNTER
Name	:	DR. GRAHAM PARKINSON
Credential	:	D.D.S.
Telephone Number	:	215-646-1665

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	04/02/2009

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