Healthcare Provider Details

I. General information

NPI: 1972893345
Provider Name (Legal Business Name): ALLIED ORTHODONTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CRESSON BLVD SUITE 210
OAKS PA
19456
US

IV. Provider business mailing address

401 COMMERCE DR SUITE 108
FORT WASHINGTON PA
19034-2714
US

V. Phone/Fax

Practice location:
  • Phone: 610-482-4334
  • Fax: 610-539-1055
Mailing address:
  • Phone: 215-529-6000
  • Fax: 215-646-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS038259
License Number StatePA

VIII. Authorized Official

Name: PHI LE
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 215-529-6000