=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205948924
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTHONLY H MAPES OMD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 MAIN STREET
-----------------------------------------------------
City | CHALFONT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19814-2912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-822-3569
-----------------------------------------------------
Fax | 215-822-0387
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 MAIN STREET
-----------------------------------------------------
City | CHALFONT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19814-2912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-822-3569
-----------------------------------------------------
Fax | 215-822-0387
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHODONTIST
-----------------------------------------------------
Name | DR. ANTHONY H MAPES
-----------------------------------------------------
Credential | DMP
-----------------------------------------------------
Telephone | 215-822-3569
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 017844L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------