Healthcare Provider Details

I. General information

NPI: 1982922209
Provider Name (Legal Business Name): PICASSO DENTAL ARTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 OLD YORK RD STE 4
ABINGTON PA
19001-1742
US

IV. Provider business mailing address

1550 OLD YORK RD STE 4
ABINGTON PA
19001-1742
US

V. Phone/Fax

Practice location:
  • Phone: 215-657-4440
  • Fax: 215-657-2412
Mailing address:
  • Phone: 215-657-4440
  • Fax: 215-657-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDS036347
License Number StatePA

VIII. Authorized Official

Name: DR. YOON LYOU
Title or Position: SOLE MEMBER
Credential: DMD
Phone: 215-657-4440