Healthcare Provider Details

I. General information

NPI: 1750300976
Provider Name (Legal Business Name): ENDODONTICS & ENDODONTIC SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 S ROLAND ST
POTTSTOWN PA
19464-5836
US

IV. Provider business mailing address

18 S ROLAND ST
POTTSTOWN PA
19464-5836
US

V. Phone/Fax

Practice location:
  • Phone: 610-327-4646
  • Fax: 610-327-3234
Mailing address:
  • Phone: 610-327-4646
  • Fax: 610-327-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS020178R
License Number StatePA

VIII. Authorized Official

Name: PAUL ROBERT KRASNER
Title or Position: OWNER/ENDODONTIST
Credential: D.D.S.
Phone: 610-327-4646