Healthcare Provider Details

I. General information

NPI: 1316493471
Provider Name (Legal Business Name): ELKINS PARK ORTHODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 OLD YORK RD SUITE 108A
ELKINS PARK PA
19027-2318
US

IV. Provider business mailing address

7900 OLD YORK RD SUITE 108A
ELKINS PARK PA
19027-2318
US

V. Phone/Fax

Practice location:
  • Phone: 215-808-6473
  • Fax: 215-638-0907
Mailing address:
  • Phone: 215-808-6473
  • Fax: 215-638-0907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS039086
License Number StatePA

VIII. Authorized Official

Name: JIAWONIA RIGHT
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-635-0808