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General NPI Number Information
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NPI Number | 1336567890
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Entity Type | Organization
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Legal Business Name | FAMILY FRIENDLY DENTAL
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 04/02/2014
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Provider Practice Location Address
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Address Line | 624 BALTIMORE PIKE
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City | SPRINGFIELD
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State | PA
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Zip | 19064-3070
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Country | US
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Telephone | 610-328-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 624 BALTIMORE PIKE
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City | SPRINGFIELD
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State | PA
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Zip | 19064-3070
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Country | US
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Telephone | 610-328-2200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RENE M POLIS
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Credential |
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Telephone | 610-356-9388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS035952
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License Number State | PA
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