Healthcare Provider Details

I. General information

NPI: 1811449374
Provider Name (Legal Business Name): POTTSTOWN PEDIATRIC DENTISTRY & ORTHODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N. POTTSTOWN PIKE SUITE 2-N
POTTSTOWN PA
19464
US

IV. Provider business mailing address

596 LANCASTER AVE SUITE 100
MALVERN PA
19355-1808
US

V. Phone/Fax

Practice location:
  • Phone: 610-337-2325
  • Fax: 610-337-3863
Mailing address:
  • Phone: 484-679-4071
  • Fax: 610-884-9296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StatePA

VIII. Authorized Official

Name: DR. JAY GOLDSLEGER
Title or Position: PRESIDENT
Credential: DDS
Phone: 610-337-2325