Healthcare Provider Details

I. General information

NPI: 1093621500
Provider Name (Legal Business Name): AUDUBON DENTAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2642 AUDUBON RD
AUDUBON PA
19403-2419
US

IV. Provider business mailing address

2642 AUDUBON RD
AUDUBON PA
19403-2419
US

V. Phone/Fax

Practice location:
  • Phone: 610-666-7590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MIRA DELLA CROCE
Title or Position: MANAGING MEMBER
Credential: DMD, FAGD
Phone: 215-200-7883