Healthcare Provider Details

I. General information

NPI: 1861302747
Provider Name (Legal Business Name): PERKIOMEN VALLEY PEDIATRIC DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 7TH ST STE 2F
PENNSBURG PA
18073-1512
US

IV. Provider business mailing address

101 W 7TH ST STE 2F
PENNSBURG PA
18073-1512
US

V. Phone/Fax

Practice location:
  • Phone: 215-514-0461
  • Fax:
Mailing address:
  • Phone: 215-514-0461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ADAM M. LEVINE
Title or Position: OWNER
Credential: DMD
Phone: 215-514-0461