Healthcare Provider Details

I. General information

NPI: 1316004567
Provider Name (Legal Business Name): DONNA L ENDY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LOCUST ST SUITE 1408
PHILADELPHIA PA
19102-4329
US

IV. Provider business mailing address

1402 W BROAD ST
QUAKERTOWN PA
18951-1110
US

V. Phone/Fax

Practice location:
  • Phone: 215-732-4450
  • Fax: 215-735-9886
Mailing address:
  • Phone: 215-536-7705
  • Fax: 215-536-7740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number035484
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: