=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053541474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAVERFORD DENTAL P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2009
-----------------------------------------------------
Last Update Date | 08/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1025 N 66TH ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19151-3104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-477-8800
-----------------------------------------------------
Fax | 215-477-8800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1215 GULPH CREEK DR
-----------------------------------------------------
City | RADNOR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19087-4687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-477-8800
-----------------------------------------------------
Fax | 215-477-8800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ONWER/ DENTIST
-----------------------------------------------------
Name | DR. VICKY CHANG ARTHUR
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 215-477-8800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS027078L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------