Healthcare Provider Details

I. General information

NPI: 1104970912
Provider Name (Legal Business Name): JAMIE NEPA GOODREAU D.M.D., M.S.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HORIZON DR STE 117
CHALFONT PA
18914-3970
US

IV. Provider business mailing address

1300 HORIZON DR STE 117
CHALFONT PA
18914-3970
US

V. Phone/Fax

Practice location:
  • Phone: 215-997-0200
  • Fax: 215-997-0659
Mailing address:
  • Phone: 215-997-0200
  • Fax: 215-997-0659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS025327L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: