Healthcare Provider Details

I. General information

NPI: 1679802136
Provider Name (Legal Business Name): MEDIA DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2009
Last Update Date: 12/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 N POTTSTOWN PIKE SUITE 100
EXTON PA
19341-2220
US

IV. Provider business mailing address

356 N POTTSTOWN PIKE SUITE 100
EXTON PA
19341-2220
US

V. Phone/Fax

Practice location:
  • Phone: 617-947-2527
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS036818
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS036849
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: YANG CHEN
Title or Position: PRESIDENT
Credential:
Phone: 617-947-2527