Healthcare Provider Details

I. General information

NPI: 1629197249
Provider Name (Legal Business Name): DR. ROBERT G DENMARK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COWPATH RD
LANSDALE PA
19446-1227
US

IV. Provider business mailing address

2121 BASSWOOD DR
LAFAYETTE HILL PA
19444-2331
US

V. Phone/Fax

Practice location:
  • Phone: 215-368-2424
  • Fax: 215-361-7292
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number028932
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: