Healthcare Provider Details

I. General information

NPI: 1336299007
Provider Name (Legal Business Name): ORTHODONTIC ASSOCIATES OF DELAWARE VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 PYLE RD
CHADDS FORD PA
19317-8934
US

IV. Provider business mailing address

101 DUTTON ST
RIDLEY PARK PA
19078-2308
US

V. Phone/Fax

Practice location:
  • Phone: 610-459-2545
  • Fax: 610-459-8876
Mailing address:
  • Phone: 610-521-2222
  • Fax: 610-521-4274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. RICHARD HAYES
Title or Position: PARTNER
Credential: DDS, MS
Phone: 610-459-2545