Healthcare Provider Details

I. General information

NPI: 1689465593
Provider Name (Legal Business Name): BUXMONT PROSTHODONTICS & RESTORATIVE DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N BROAD ST STE 104
LANSDALE PA
19446-1052
US

IV. Provider business mailing address

2100 N BROAD ST STE 104
LANSDALE PA
19446-1052
US

V. Phone/Fax

Practice location:
  • Phone: 215-855-3233
  • Fax: 215-855-8029
Mailing address:
  • Phone: 215-855-3233
  • Fax: 215-855-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: MRS. THERESA A ROMANO
Title or Position: STAFF
Credential:
Phone: 215-855-3233