Healthcare Provider Details

I. General information

NPI: 1659670479
Provider Name (Legal Business Name): PAOLI DENTAL ARTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E LANCASTER AVE
PAOLI PA
19301-1533
US

IV. Provider business mailing address

1800 E LANCASTER AVE
PAOLI PA
19301-1533
US

V. Phone/Fax

Practice location:
  • Phone: 610-651-5611
  • Fax: 610-651-0488
Mailing address:
  • Phone: 610-651-5611
  • Fax: 610-651-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS027921L
License Number StatePA

VIII. Authorized Official

Name: MRS. DAWN PRISCO
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-568-8130