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General NPI Number Information
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NPI Number | 1124126891
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Entity Type | Organization
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Legal Business Name | POTTSTOWN DENTAL PROFESSIONALS LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 933 N CHARLOTTE ST SUITE 2D
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City | POTTSTOWN
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State | PA
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Zip | 19464
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Country | US
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Telephone | 610-326-8785
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Fax | 610-326-7043
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Provider Business Mailing Address
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Address Line | 933 N CHARLOTTE ST SUITE 2D
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City | POTTSTOWN
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State | PA
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Zip | 19464
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Country | US
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Telephone | 610-326-8785
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Fax | 610-326-7043
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. ROBERT LOUIS SANSONE
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Credential | DDS
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Telephone | 610-326-8785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DX020446R
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS028302L
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License Number State | PA
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