Healthcare Provider Details

I. General information

NPI: 1609028414
Provider Name (Legal Business Name): INFINITE ENDODONTICS PENNSYLVANIA P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 SCHOOL LN 104
HARLEYSVILLE PA
19438-1715
US

IV. Provider business mailing address

456 SCHOOL LN 104
HARLEYSVILLE PA
19438-1715
US

V. Phone/Fax

Practice location:
  • Phone: 215-513-7172
  • Fax: 215-513-7192
Mailing address:
  • Phone: 215-513-7172
  • Fax: 215-513-7192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS030449L
License Number StatePA

VIII. Authorized Official

Name: SPENCER CARL SAINT CYR
Title or Position: OWNER
Credential: DMD
Phone: 215-513-7172