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General NPI Number Information
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NPI Number | 1134642382
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Entity Type | Organization
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Legal Business Name | ORTHODONTIC SPECIALISTS OF THE INDIAN VALLEY, PLLC
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 726 ROUTE 113
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City | SOUDERTON
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State | PA
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Zip | 18964-1004
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Country | US
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Telephone | 267-225-8932
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Fax |
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Provider Business Mailing Address
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Address Line | 726 ROUTE 113
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City | SOUDERTON
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State | PA
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Zip | 18964-1004
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Country | US
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Telephone | 267-225-8932
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN SILVESTRE
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Credential | DMD
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Telephone | 267-225-8932
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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 |
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License Number State |
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