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General NPI Number Information
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NPI Number | 1013332626
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Entity Type | Organization
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Legal Business Name | DJ ORTHODONTICS LLC
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 3611 PERKIOMEN AVE
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City | READING
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State | PA
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Zip | 19606-2712
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Country | US
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Telephone | 610-401-0559
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Fax |
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Provider Business Mailing Address
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Address Line | 202 EXTON CMNS
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City | EXTON
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State | PA
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Zip | 19341-2449
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. MELISSA DUGAN
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Credential |
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Telephone | 484-809-5167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS038518
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License Number State | PA
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