=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104199355
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK ENTRESS DEFORNO DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2012
-----------------------------------------------------
Last Update Date | 10/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1507 MCDANIEL DR
-----------------------------------------------------
City | WEST CHESTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19380-6671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-363-1980
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3105 C G ZINN RD
-----------------------------------------------------
City | THORNDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19372-1131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-384-2541
-----------------------------------------------------
Fax | 610-384-8638
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN001715
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------