MEDICARE: DENTAL PROFESSIONALS OF PENNSYLVANIA, P.C.

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	:	1992303747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL PROFESSIONALS OF PENNSYLVANIA, P.C.

Provider Business Mailing Address
First Line	:	403 S JULIANA ST
Second Line	:
City	:	BEDFORD
State	:	PA
Zip	:	15522-1825
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 S JULIANA ST
Second Line	:
City	:	BEDFORD
State	:	PA
Zip	:	15522-1825
Country	:	US
Telephone Number	:	814-623-8747
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	TABATHA LEMKE
Credential	:
Telephone Number	:	217-540-6078

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	10/14/2020

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