Healthcare Provider Details

I. General information

NPI: 1780780387
Provider Name (Legal Business Name): LINDA BARBARA EDELSON-SLOCUM D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CHERRY BLOSSOM DR
CHURCHVILLE PA
18966-1061
US

IV. Provider business mailing address

5 CHERRY BLOSSOM DR
CHURCHVILLE PA
18966-1061
US

V. Phone/Fax

Practice location:
  • Phone: 215-322-5361
  • Fax: 215-322-3923
Mailing address:
  • Phone: 215-322-5361
  • Fax: 215-322-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS024052L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: