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General NPI Number Information
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NPI Number | 1174965578
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Entity Type | Individual
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Provider Name | STEPHEN R AU
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Gender | Male
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 113 BETHLEHEM PIKE
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City | COLMAR
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State | PA
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Zip | 18915-9797
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Country | US
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Telephone | 215-996-1818
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 ELON CIR
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City | FORT WASHINGTON
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State | PA
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Zip | 19034-1737
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Country | US
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Telephone | 215-870-5123
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DS039697
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License Number State | PA
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