Healthcare Provider Details

I. General information

NPI: 1174611065
Provider Name (Legal Business Name): DENTRUST DENTAL MASSACHUSETTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 CAFFERTY RD
PIPERSVILLE PA
18947-9337
US

IV. Provider business mailing address

254 CAFFERTY RD
PIPERSVILLE PA
18947-9337
US

V. Phone/Fax

Practice location:
  • Phone: 610-294-7994
  • Fax: 610-294-7995
Mailing address:
  • Phone: 610-294-7994
  • Fax: 610-294-7995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BARBARA STOVER
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 610-294-7994