Healthcare Provider Details

I. General information

NPI: 1427118082
Provider Name (Legal Business Name): EGYPT ROAD DENTAL ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 EGYPT ROAD
RUDUBAN PA
19403
US

IV. Provider business mailing address

2705 EGYPT ROAD
RUDUBAN PA
19403
US

V. Phone/Fax

Practice location:
  • Phone: 610-666-6585
  • Fax: 610-666-1357
Mailing address:
  • Phone: 610-666-6585
  • Fax: 610-666-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS027842L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BARRY C FOSTER
Title or Position: OWNER DENTIST
Credential:
Phone: 610-666-6585