Healthcare Provider Details

I. General information

NPI: 1073449930
Provider Name (Legal Business Name): WILLOWDALE FAMILY DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 UNIONVILLE RD
KENNETT SQUARE PA
19348-1704
US

IV. Provider business mailing address

808 FOUNTAIN TRL
KENNETT SQUARE PA
19348-1927
US

V. Phone/Fax

Practice location:
  • Phone: 814-558-2731
  • Fax:
Mailing address:
  • Phone: 814-558-2731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN AUSTIN
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 814-558-2731