Healthcare Provider Details

I. General information

NPI: 1669943965
Provider Name (Legal Business Name): MARY BETH GEBELEIN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 PENN ST
READING PA
19602-1108
US

IV. Provider business mailing address

4605 SPRINGFIELD AVE # 1R
PHILADELPHIA PA
19143-3693
US

V. Phone/Fax

Practice location:
  • Phone: 610-988-4838
  • Fax: 610-288-4515
Mailing address:
  • Phone: 484-431-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH008042L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: