Healthcare Provider Details

I. General information

NPI: 1912436874
Provider Name (Legal Business Name): BIANCA KREIDER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 RIDGE AVE
PHILADELPHIA PA
19128-2446
US

IV. Provider business mailing address

741 SPRING MILL AVE
CONSHOHOCKEN PA
19428-1953
US

V. Phone/Fax

Practice location:
  • Phone: 215-483-6633
  • Fax:
Mailing address:
  • Phone: 240-441-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberUNKNOWN
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number00203918
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS042918
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: