Healthcare Provider Details

I. General information

NPI: 1780239228
Provider Name (Legal Business Name): HATBORO DENTAL & SPECIALTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N YORK RD STE 2
HATBORO PA
19040-2622
US

IV. Provider business mailing address

122 N YORK RD STE 2
HATBORO PA
19040-2622
US

V. Phone/Fax

Practice location:
  • Phone: 215-443-5400
  • Fax: 215-957-0334
Mailing address:
  • Phone: 215-443-5400
  • Fax: 215-957-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN SCHNEIDER
Title or Position: OWNER
Credential: DMD
Phone: 215-443-5400