=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144367293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIGHPOINT PEDIATRIC DENTAL ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 HORIZON DR . SUITE 101
-----------------------------------------------------
City | CHALFONT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-822-4042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 HORIZON DRIVE SUITE 101
-----------------------------------------------------
City | CHALFONT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-822-4042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER - DENTIST
-----------------------------------------------------
Name | DR. IBRAHIM DURRA
-----------------------------------------------------
Credential | D.M.D
-----------------------------------------------------
Telephone | 215-822-4042
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------