Healthcare Provider Details

I. General information

NPI: 1407205370
Provider Name (Legal Business Name): MATTHEW J CAMBRIA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 ANNA AVE
BLANDON PA
19510-9311
US

IV. Provider business mailing address

109 ANNA AVE PO BOX 260
BLANDON PA
19510-9311
US

V. Phone/Fax

Practice location:
  • Phone: 610-926-1233
  • Fax: 610-916-7640
Mailing address:
  • Phone: 610-926-1233
  • Fax: 610-916-7640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS040830
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: