Healthcare Provider Details

I. General information

NPI: 1487887550
Provider Name (Legal Business Name): DONALD C BEDROSIAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N BROAD ST SUITE 203
LANSDALE PA
19446-1052
US

IV. Provider business mailing address

2100 N BROAD ST SUITE 203
LANSDALE PA
19446-1052
US

V. Phone/Fax

Practice location:
  • Phone: 215-855-4092
  • Fax: 215-855-2061
Mailing address:
  • Phone: 215-855-4092
  • Fax: 215-855-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number017366
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: