Healthcare Provider Details

I. General information

NPI: 1275220865
Provider Name (Legal Business Name): BUXMONT PERIODONTICS AND DENTAL IMPLANTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 N MAIN ST UNIT 1
DUBLIN PA
18917-2107
US

IV. Provider business mailing address

391 ESSEX CT
PERKASIE PA
18944-1297
US

V. Phone/Fax

Practice location:
  • Phone: 267-873-4044
  • Fax: 267-873-4077
Mailing address:
  • Phone: 267-307-2358
  • Fax: 267-873-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH LEONARD MUSTAZZA
Title or Position: OWNER/ PERIODONTIST
Credential: DMD MS
Phone: 267-307-2358