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General NPI Number Information
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NPI Number | 1376297986
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Entity Type | Organization
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Legal Business Name | INDIJU 6 DENTAL LLC
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Dates
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Enumeration Date | 02/11/2022
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 757 FREDERICKS GROVE RD
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City | LEHIGHTON
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State | PA
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Zip | 18235-9716
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Country | US
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Telephone | 570-386-6910
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Fax |
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Provider Business Mailing Address
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Address Line | 245 DUNHAM DR
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City | HUMMELSTOWN
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State | PA
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Zip | 17036-8040
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Country | US
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Telephone | 717-991-8750
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BARRY ALLYN MOSS
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Credential | DMD
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Telephone | 717-991-8750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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