Healthcare Provider Details

I. General information

NPI: 1083931703
Provider Name (Legal Business Name): ARCHANA TADISENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 UNION BLVD
ALLENTOWN PA
18109-1676
US

IV. Provider business mailing address

401 COMMERCE DR SUITE 108
FORT WASHINGTON PA
19034-2714
US

V. Phone/Fax

Practice location:
  • Phone: 610-437-5353
  • Fax: 610-439-5760
Mailing address:
  • Phone: 215-550-7186
  • Fax: 215-646-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS038123
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: