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General NPI Number Information
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NPI Number | 1144591140
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Entity Type | Organization
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Legal Business Name | JDM PARTNERS LLC
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 123 OLD YORK RD SUITE 201
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City | JENKINTOWN
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State | PA
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Zip | 19046-3926
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Country | US
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Telephone | 215-885-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 200 HIGHPOINT DR SUITE 220
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City | CHALFONT
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State | PA
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Zip | 18914-3925
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Country | US
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Telephone | 215-822-1866
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Fax |
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Authorized Official
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Title or Position | CHIEF DENTAL OFFICER
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Name | DR. BRIAN WILK
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Credential | D.M.D
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Telephone | 215-822-1866
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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 | DS027199L
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License Number State | PA
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