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General NPI Number Information
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NPI Number | 1184643389
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Entity Type | Organization
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Legal Business Name | QUAKERTOWN PERIODONTAL ASSOCIATES
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1402 W BROAD ST
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City | QUAKERTOWN
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State | PA
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Zip | 18951-1110
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Country | US
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Telephone | 215-538-0551
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Fax |
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Provider Business Mailing Address
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Address Line | 1402 W BROAD ST
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City | QUAKERTOWN
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State | PA
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Zip | 18951-1110
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Country | US
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Telephone | 215-538-0551
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | DR. BRUCE DORDICK
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Credential | DDS
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Telephone | 215-538-0551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DS017728L
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License Number State | PA
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