Healthcare Provider Details

I. General information

NPI: 1841464468
Provider Name (Legal Business Name): ORTHODONTIC PROFESSIONALS P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 SCHOOL LN SUITE # 102
HARLEYSVILLE PA
19438-1715
US

IV. Provider business mailing address

456 SCHOOL LN SUITE # 102
HARLEYSVILLE PA
19438-1715
US

V. Phone/Fax

Practice location:
  • Phone: 215-513-1551
  • Fax: 215-513-7192
Mailing address:
  • Phone: 215-513-1551
  • Fax: 215-513-7192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS036430
License Number StatePA

VIII. Authorized Official

Name: CATHERINE FOOTE
Title or Position: OWNER
Credential: DMD
Phone: 215-513-1551