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General NPI Number Information
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NPI Number | 1023904422
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF NEWTOWN SQUARE, LLC
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 3475 W CHESTER PIKE STE 220
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073-4291
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Country | US
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Telephone | 484-473-9645
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Fax | 484-473-9685
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Provider Business Mailing Address
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Address Line | 516 S MEDIA WAY
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City | MEDIA
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State | PA
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Zip | 19063-3267
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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 | OWNER
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Name | DR. JOANNA MANGAR
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Credential | DMD
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Telephone | 484-473-9645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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