Healthcare Provider Details

I. General information

NPI: 1831317254
Provider Name (Legal Business Name): UPPER MERION PERIODONTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 S GULPH RD SUITE 100
KING OF PRUSSIA PA
19406-3174
US

IV. Provider business mailing address

357 S GULPH RD SUITE 100
KING OF PRUSSIA PA
19406-3174
US

V. Phone/Fax

Practice location:
  • Phone: 610-337-2325
  • Fax: 610-337-3863
Mailing address:
  • Phone: 610-337-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT SMITH
Title or Position: DENTIST
Credential: DDS
Phone: 610-337-2325