Healthcare Provider Details

I. General information

NPI: 1801814728
Provider Name (Legal Business Name): BUCKS COUNTY PERIODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3554 HULMEVILLE RD STE 109
BENSALEM PA
19020-4366
US

IV. Provider business mailing address

3554 HULMEVILLE RD STE 109
BENSALEM PA
19020-4366
US

V. Phone/Fax

Practice location:
  • Phone: 215-639-7770
  • Fax:
Mailing address:
  • Phone: 215-639-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS-025192-L
License Number StatePA

VIII. Authorized Official

Name: DR. ALAN LAWRENCE KROCHTENGEL
Title or Position: OWNER
Credential: D.M.D
Phone: 215-639-7770