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NPI Code Detail

MEDICARE: INFINITY DENTAL MANAGEMENT LLC

MEDICARE: INFINITY DENTAL MANAGEMENT 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
1122300000XDentistDS036255LPA

General Provider Information

NPI Number : 1730432287
Entity Type Code : Organization
Provider Name (Legal Business Name) : INFINITY DENTAL MANAGEMENT LLC
Provider Business Mailing Address
First Line : 532 S OXFORD VALLEY RD
Second Line :
City : FAIRLESS HILLS
State : PA
Zip : 19030-2615
Country : US
Telephone Number : 215-946-3655
Fax Number : 215-946-1041
Provider Business Practice Location Address
First Line : 532 S OXFORD VALLEY RD
Second Line :
City : FAIRLESS HILLS
State : PA
Zip : 19030-2615
Country : US
Telephone Number : 215-946-3655
Fax Number : 215-946-1041
Authorized Official
Title or Position : INSURANCE MANAGER
Name : LISA A RADER
Credential :
Telephone Number : 215-750-2254
Provider Enumeration Date : 10/22/2012
Last Update Date : 10/22/2012

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Directions to “INFINITY DENTAL MANAGEMENT LLC ” Practice Location

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