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General NPI Number Information
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NPI Number | 1265730535
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL CARE
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 344 N WYOMISSING BLVD
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City | WYOMISSING
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State | PA
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Zip | 19610-2936
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Country | US
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Telephone | 610-375-3844
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Fax |
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Provider Business Mailing Address
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Address Line | 344 N WYOMISSING BLVD
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City | WYOMISSING
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State | PA
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Zip | 19610-2936
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Country | US
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Telephone | 610-375-3844
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PRECIOSA PEREZ
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Credential | DDS
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Telephone | 610-375-3844
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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 | DS031182L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS035069
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License Number State | PA
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